Polyarteritis Nodosa-like Vasculitis in Association with Minocycline Use: A Single-Center Case Series

Tanaz A. Kermani, Erin K. Ham, Michael J. Camilleri, Kenneth J Warrington

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: To describe the clinical features, treatment, and outcomes of polyarteritis nodosa (PAN)-like vasculitis in association with minocycline therapy. Methods: We identified all subjects ≥18 years old with PAN-like vasculitis in the context of minocycline use seen at our institution between January 1995 and October 2010. Cases of hepatitis B-associated PAN were excluded. PAN was defined based on angiographic findings or tissue biopsy. Minocycline use was defined as medication use at the time of onset of first symptom. Results: We identified 9 patients (5 females; 56%) with a median age of 30 (range 18 to 55) years. Four patients (44%) had isolated cutaneous disease, while 5 cases (56%) had systemic involvement including renal artery microaneurysms (2 patients), cholecystitis (1 patient), mononeuritis multiplex (2 patients), and mesenteric vasculitis (1 patient). Median duration of minocycline use was 2 (range 1 to 4) years. Three patients had a positive antinuclear antibody with negative extractable nuclear antigen antibodies. All patients had positive antineutrophil cytoplasmic antibody in a perinuclear pattern but specificity to myeloperoxidase was observed in 2 patients (22%). Diagnosis was confirmed by histopathology in 6 patients (67%) and angiography in 3 patients (33%). Minocycline was discontinued in all cases. Further immunosuppressive therapy was added in 6 cases (67%). Conclusions: Cutaneous, as well as systemic, PAN-like vasculitis may occur in association with minocycline use. Clinicians should consider the possibility of drug-induced vasculitis, especially in cases of medium-vessel vasculitis with atypical antineutrophil cytoplasmic antibody serologies or in patients with negative hepatitis B testing.

Original languageEnglish (US)
Pages (from-to)213-221
Number of pages9
JournalSeminars in Arthritis and Rheumatism
Volume42
Issue number2
DOIs
StatePublished - Oct 2012

Fingerprint

Polyarteritis Nodosa
Minocycline
Vasculitis
Antineutrophil Cytoplasmic Antibodies
Hepatitis B
Mononeuropathies
Nuclear Antigens
Cholecystitis
Antinuclear Antibodies
Renal Artery
Serology
Immunosuppressive Agents
Skin Diseases
Peroxidase
Angiography

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

Cite this

Polyarteritis Nodosa-like Vasculitis in Association with Minocycline Use : A Single-Center Case Series. / Kermani, Tanaz A.; Ham, Erin K.; Camilleri, Michael J.; Warrington, Kenneth J.

In: Seminars in Arthritis and Rheumatism, Vol. 42, No. 2, 10.2012, p. 213-221.

Research output: Contribution to journalArticle

@article{a2bdfd940ffc4baeb2fde449df9606e8,
title = "Polyarteritis Nodosa-like Vasculitis in Association with Minocycline Use: A Single-Center Case Series",
abstract = "Objective: To describe the clinical features, treatment, and outcomes of polyarteritis nodosa (PAN)-like vasculitis in association with minocycline therapy. Methods: We identified all subjects ≥18 years old with PAN-like vasculitis in the context of minocycline use seen at our institution between January 1995 and October 2010. Cases of hepatitis B-associated PAN were excluded. PAN was defined based on angiographic findings or tissue biopsy. Minocycline use was defined as medication use at the time of onset of first symptom. Results: We identified 9 patients (5 females; 56{\%}) with a median age of 30 (range 18 to 55) years. Four patients (44{\%}) had isolated cutaneous disease, while 5 cases (56{\%}) had systemic involvement including renal artery microaneurysms (2 patients), cholecystitis (1 patient), mononeuritis multiplex (2 patients), and mesenteric vasculitis (1 patient). Median duration of minocycline use was 2 (range 1 to 4) years. Three patients had a positive antinuclear antibody with negative extractable nuclear antigen antibodies. All patients had positive antineutrophil cytoplasmic antibody in a perinuclear pattern but specificity to myeloperoxidase was observed in 2 patients (22{\%}). Diagnosis was confirmed by histopathology in 6 patients (67{\%}) and angiography in 3 patients (33{\%}). Minocycline was discontinued in all cases. Further immunosuppressive therapy was added in 6 cases (67{\%}). Conclusions: Cutaneous, as well as systemic, PAN-like vasculitis may occur in association with minocycline use. Clinicians should consider the possibility of drug-induced vasculitis, especially in cases of medium-vessel vasculitis with atypical antineutrophil cytoplasmic antibody serologies or in patients with negative hepatitis B testing.",
author = "Kermani, {Tanaz A.} and Ham, {Erin K.} and Camilleri, {Michael J.} and Warrington, {Kenneth J}",
year = "2012",
month = "10",
doi = "10.1016/j.semarthrit.2012.03.006",
language = "English (US)",
volume = "42",
pages = "213--221",
journal = "Seminars in Arthritis and Rheumatism",
issn = "0049-0172",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Polyarteritis Nodosa-like Vasculitis in Association with Minocycline Use

T2 - A Single-Center Case Series

AU - Kermani, Tanaz A.

AU - Ham, Erin K.

AU - Camilleri, Michael J.

AU - Warrington, Kenneth J

PY - 2012/10

Y1 - 2012/10

N2 - Objective: To describe the clinical features, treatment, and outcomes of polyarteritis nodosa (PAN)-like vasculitis in association with minocycline therapy. Methods: We identified all subjects ≥18 years old with PAN-like vasculitis in the context of minocycline use seen at our institution between January 1995 and October 2010. Cases of hepatitis B-associated PAN were excluded. PAN was defined based on angiographic findings or tissue biopsy. Minocycline use was defined as medication use at the time of onset of first symptom. Results: We identified 9 patients (5 females; 56%) with a median age of 30 (range 18 to 55) years. Four patients (44%) had isolated cutaneous disease, while 5 cases (56%) had systemic involvement including renal artery microaneurysms (2 patients), cholecystitis (1 patient), mononeuritis multiplex (2 patients), and mesenteric vasculitis (1 patient). Median duration of minocycline use was 2 (range 1 to 4) years. Three patients had a positive antinuclear antibody with negative extractable nuclear antigen antibodies. All patients had positive antineutrophil cytoplasmic antibody in a perinuclear pattern but specificity to myeloperoxidase was observed in 2 patients (22%). Diagnosis was confirmed by histopathology in 6 patients (67%) and angiography in 3 patients (33%). Minocycline was discontinued in all cases. Further immunosuppressive therapy was added in 6 cases (67%). Conclusions: Cutaneous, as well as systemic, PAN-like vasculitis may occur in association with minocycline use. Clinicians should consider the possibility of drug-induced vasculitis, especially in cases of medium-vessel vasculitis with atypical antineutrophil cytoplasmic antibody serologies or in patients with negative hepatitis B testing.

AB - Objective: To describe the clinical features, treatment, and outcomes of polyarteritis nodosa (PAN)-like vasculitis in association with minocycline therapy. Methods: We identified all subjects ≥18 years old with PAN-like vasculitis in the context of minocycline use seen at our institution between January 1995 and October 2010. Cases of hepatitis B-associated PAN were excluded. PAN was defined based on angiographic findings or tissue biopsy. Minocycline use was defined as medication use at the time of onset of first symptom. Results: We identified 9 patients (5 females; 56%) with a median age of 30 (range 18 to 55) years. Four patients (44%) had isolated cutaneous disease, while 5 cases (56%) had systemic involvement including renal artery microaneurysms (2 patients), cholecystitis (1 patient), mononeuritis multiplex (2 patients), and mesenteric vasculitis (1 patient). Median duration of minocycline use was 2 (range 1 to 4) years. Three patients had a positive antinuclear antibody with negative extractable nuclear antigen antibodies. All patients had positive antineutrophil cytoplasmic antibody in a perinuclear pattern but specificity to myeloperoxidase was observed in 2 patients (22%). Diagnosis was confirmed by histopathology in 6 patients (67%) and angiography in 3 patients (33%). Minocycline was discontinued in all cases. Further immunosuppressive therapy was added in 6 cases (67%). Conclusions: Cutaneous, as well as systemic, PAN-like vasculitis may occur in association with minocycline use. Clinicians should consider the possibility of drug-induced vasculitis, especially in cases of medium-vessel vasculitis with atypical antineutrophil cytoplasmic antibody serologies or in patients with negative hepatitis B testing.

UR - http://www.scopus.com/inward/record.url?scp=84866483955&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866483955&partnerID=8YFLogxK

U2 - 10.1016/j.semarthrit.2012.03.006

DO - 10.1016/j.semarthrit.2012.03.006

M3 - Article

C2 - 22704357

AN - SCOPUS:84866483955

VL - 42

SP - 213

EP - 221

JO - Seminars in Arthritis and Rheumatism

JF - Seminars in Arthritis and Rheumatism

SN - 0049-0172

IS - 2

ER -