Teitelbaum J E, Perez-Atayde A R, Cohen M, Bousvaros A, Jonas M M
Combined Program in Gastroenterology and Nutrition, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Arch Pediatr Adolesc Med. 1998 Nov;152(11):1132-6. doi: 10.1001/archpedi.152.11.1132.
Minocycline is an antibiotic commonly used in the treatment of adolescent acne.
To describe the clinical, laboratory, and histological features in 3 cases of minocycline-related autoimmune hepatitis and to review the literature of similar cases in the adolescent population.
Case series.
Patients were cared for in the Division of Gastroenterology, Children's Hospital, Boston, Mass.
Three adolescents (age, 15-16 years), while being treated with therapeutic doses of minocycline for periods of 12 to 20 months, met the 1993 International Autoimmune Hepatitis Group criteria for autoimmune hepatitis. All had a positive antinuclear antibody titer. Other features included hypergammaglobulinemia and a positive anti-smooth muscle antibody titer. Two patients underwent liver biopsy that revealed severe chronic lymphoplasmacytic inflammation, necrosis, and fibrosis. All other causes of liver disease were excluded. One patient had resolution of symptoms with withdrawal of the drug, while 2 required immunosuppression therapy. A review of the literature yielded only 18 similar cases, none in the pediatric literature, the majority of which contained incomplete pertinent data.
Minocycline is related to the development of autoimmune hepatitis in some adolescents. Pediatricians who use this drug for treatment of acne should be aware of this serious potential relation and stop the drug immediately when suspicion is raised.
米诺环素是一种常用于治疗青少年痤疮的抗生素。
描述3例米诺环素相关自身免疫性肝炎的临床、实验室及组织学特征，并复习青少年人群中类似病例的文献。
病例系列。
患者在马萨诸塞州波士顿儿童医院胃肠病科接受治疗。
3名青少年（年龄15 - 16岁）在接受治疗剂量的米诺环素治疗12至20个月期间，符合1993年国际自身免疫性肝炎小组制定的自身免疫性肝炎标准。所有患者抗核抗体滴度均为阳性。其他特征包括高球蛋白血症和抗平滑肌抗体滴度阳性。2例患者接受了肝活检，结果显示严重的慢性淋巴细胞浆细胞炎症、坏死和纤维化。排除了所有其他肝病病因。1例患者停药后症状缓解，而另外2例需要免疫抑制治疗。文献复习仅发现18例类似病例，儿科文献中无相关报道，且大多数病例的相关数据不完整。
米诺环素与部分青少年自身免疫性肝炎的发生有关。使用该药治疗痤疮的儿科医生应意识到这种严重的潜在关联，当怀疑出现时应立即停药。
