Schaffer J V, Davidson D M, McNiff J M, Bolognia J L
Department of Dermatology, Yale University School of Medicine, New Haven CT, USA.
J Am Acad Dermatol. 2001 Feb;44(2):198-206. doi: 10.1067/mjd.2001.112218.
Minocycline is an oral antibiotic widely used for the long-term treatment of acne vulgaris. Unusual side effects of this medication include two overlapping autoimmune syndromes: drug-induced lupus and autoimmune hepatitis. In addition, in a few patients livedo reticularis or subcutaneous nodules have developed in association with arthritis and serum perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) during long-term minocycline therapy. We report the cases of two young women receiving long-term minocycline therapy (>3 years) in whom P-ANCA-positive cutaneous polyarteritis nodosa developed. Both patients presented with a violaceous reticulated pattern on the lower extremities. Histologic examination of biopsy specimens from a reticulated area and a subcutaneous nodule showed necrotizing vasculitis of medium-sized arteries in the deep dermis, consistent with the diagnosis of polyarteritis nodosa. The cutaneous lesions rapidly resolved on discontinuation of minocycline and initiation of prednisone therapy. A high index of suspicion and testing for antineutrophil cytoplasmic antibody in addition to the standard antinuclear antibody panel can facilitate diagnosis of minocycline-related autoimmune disorders.
米诺环素是一种口服抗生素，广泛用于寻常痤疮的长期治疗。这种药物的不寻常副作用包括两种重叠的自身免疫综合征：药物性狼疮和自身免疫性肝炎。此外，在少数患者中，长期使用米诺环素治疗期间会出现网状青斑或皮下结节，并伴有关节炎和血清核周抗中性粒细胞胞浆抗体（P-ANCA）。我们报告了两名接受长期米诺环素治疗（>3年）的年轻女性病例，她们发生了P-ANCA阳性的皮肤结节性多动脉炎。两名患者下肢均出现紫红色网状图案。对网状区域和皮下结节的活检标本进行组织学检查，显示真皮深层中动脉的坏死性血管炎，符合结节性多动脉炎的诊断。停用米诺环素并开始泼尼松治疗后，皮肤病变迅速消退。除了标准的抗核抗体检测外，高度怀疑并检测抗中性粒细胞胞浆抗体有助于诊断与米诺环素相关的自身免疫性疾病。
