Reversible drug-induced antiphospholipid syndrome

Area of Science:

• Internal Medicine
• Neurology
• Rheumatology

Background:

• Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis.
• Drug-induced APS is rare, with limited evidence linking specific medications to its development.

Observation:

• A young male patient developed recurrent strokes while on minocycline therapy for acne.
• Neurological events included lateral medullary syndrome and oculomotor nerve nucleus infarction.
• High titers of anti-beta 2 glycoprotein 1 (antiβ2GP1) and antiphosphatidylethanolamine antibodies were detected.

Findings:

• Discontinuation of minocycline resulted in a significant decrease in antiβ2GP1 antibody levels.
• Antibody titers normalized within six months and remained negative for six years.
• This represents the first reported case of minocycline-induced APS with complete antibody normalization after drug withdrawal.

Implications:

• Minocycline should be considered a potential cause of drug-induced APS.
• Monitoring antiphospholipid antibody levels is crucial in patients with suspected drug-induced APS, even with initially high titers.
• This case highlights the importance of medication review in managing recurrent thrombotic events.