Minocycline‐induced lupus: clinical features and response to rechallenge

Abstract

Objective. To describe the spectrum of clinical features in patients with minocycline‐induced lupus (MIL) and determine their response to rechallenge.

Methods. The clinical features and laboratory findings of 23 patients with MIL were recorded. Ten patients were rechallenged, and their C‐reactive protein (CRP) levels were monitored.

Results. All subjects complained of polyarthralgia; three had metacarpophalangeal and proximal interphalangeal joint synovitis and one had bilateral knee effusions. Elevated hepatic transaminases were noted in eight subjects. Cutaneous vasculitis was a feature in two cases. None had renal or central nervous system disease, although five patients complained of impaired concentration and poor memory and a single patient had a peripheral sensory neuropathy. The following serological abnormalities were detected: antinuclear antibodies (19/23 patients); antibodies to double‐stranded DNA (4/23); perinuclear antineutrophil cytoplasmic antibodies (10/15); IgG anti‐cardiolipin antibodies (6/23); hypergammaglobulinaemia (12/19). Anti‐histone antibodies were negative in 9/9 cases. Rechallenge resulted in rapid recurrence of symptoms and elevation of CRP levels.

Conclusion. MIL is associated with a wide spectrum of clinical and serological features. The diagnosis can be confirmed by rechallenge, which results in rapid reappearance of symptoms and a rise in CRP.

Minocycline, CRP, SLE, Drug‐induced lupus, Rechallenge.