Minocycline-induced cell-mediated hypersensitivity pneumonitis.

OBJECTIVE

To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis.

DESIGN

Case study.

SETTING

Intensive care unit of a referral hospital.

PATIENT

A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amoxicillin, and erythromycin.

INTERVENTION

Sequential bronchoalveolar lavages after reexposure to minocycline and amoxicillin.

MEASUREMENTS

Immunologic analysis of the phenotype and function of alveolar lymphocytes.

RESULTS

Reexposure to minocycline but not to amoxicillin was followed by an interstitial pneumonitis. Sequential bronchoalveolar lavages showed a transient rise of eosinophils and neutrophils and a persistent alveolar lymphocytosis. Alveolar lymphocytes consisted predominantly of CD8+ but also CD4+ cells. Two CD8+ lymphocyte subsets were identified: CD8+ D44+ cytotoxic T cells that increased rapidly after the drug was resumed and CD8+ CD57+ suppressor T cells that predominated 11 days after the drug's withdrawal. In-vitro assays showed the presence of a lymphocyte-mediated specific cytotoxicity against minocycline-bearing alveolar macrophages.

CONCLUSION

These results support the hypothesis of a central role of T lymphocytes in the pathogenesis of drug-related hypersensitivity pneumonitis.