Vermeijden Harmen D, van der List Jelle P, Chen Yao-Tseng, DiFelice Gregory S
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, United States.
Amsterdam UMC, University of Amsterdam Department of Orthopaedic Surgery, Amsterdam, the Netherlands.
Int J Surg Case Rep. 2021 Apr;81:105819. doi: 10.1016/j.ijscr.2021.105819. Epub 2021 Mar 23.
Long-term use of minocycline at high doses is associated with hyperpigmentation with multiple sites of involvement. While the cutaneous organs and the oral cavity are most commonly affected, bone discoloration is a rare entity.
A 19-year-old male patient with a history of acne vulgaris and intermittent treatment with high dose minocycline for three years presented with recurrent anterior cruciate ligament (ACL) tear. During arthroscopic surgery, however, hyperpigmentation of the femur and synovium was observed. Abnormal tissue was biopsied and confirmed through histopathological examination to contain melanin-related minocycline pigmentation. Revision surgery was re-scheduled with no intraoperative complications and excellent long-term clinical outcomes.
There are several possible causes of hyperpigmentation, including hemosiderin deposition, infection, aseptic necrosis, demineralization, and metastatic disease. Black bone disease, caused by minocycline-induced hyperpigmentation, is rare. While the appearance is grossly abnormal in black bone disease, there has been no evidence suggesting that tissue integrity is compromised.
This case confirms that hyperpigmentation does not affect bone integrity and that surgical procedures can be performed safely. Knowing the adverse effects of minocycline administration could reduce inappropriate postponement of surgical procedures, thereby saving time and resources.
长期高剂量使用米诺环素与多部位色素沉着有关。虽然皮肤器官和口腔最常受累，但骨骼变色是一种罕见情况。
一名19岁男性患者，有寻常痤疮病史，曾间断高剂量使用米诺环素三年，现出现复发性前交叉韧带（ACL）撕裂。然而，在关节镜手术中，观察到股骨和滑膜色素沉着。对异常组织进行活检，并通过组织病理学检查确认含有与米诺环素相关的黑色素沉着。重新安排了翻修手术，术中无并发症，长期临床效果良好。
色素沉着有几种可能的原因，包括含铁血黄素沉积、感染、无菌性坏死、脱矿质和转移性疾病。由米诺环素引起的色素沉着导致的黑骨病很罕见。虽然黑骨病的外观明显异常，但没有证据表明组织完整性受到损害。
该病例证实色素沉着不影响骨骼完整性，手术可安全进行。了解米诺环素给药的不良反应可减少手术的不当延迟，从而节省时间和资源。
