Antineutrophil cytoplasmic antibodies and HLA class II alleles in minocycline-induced lupus-like syndrome
✍ Scribed by J. Dunphy; M. Oliver; A.L. Rands; C.R. Lovell; N.J. Mchugh
- Publisher
- John Wiley and Sons
- Year
- 2000
- Tongue
- English
- Weight
- 332 KB
- Volume
- 142
- Category
- Article
- ISSN
- 0007-0963
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✦ Synopsis
Abstract
We report 14 patients with minocycline-induced lupus-like syndrome (four men, 10 women; mean age 27·8 years) who developed a lupus-like illness after chronic use of minocycline for acne (1–10 years, median 3·8). Clinical features resolved completely on drug withdrawal (mean follow-up 11 months) and reappeared in two patients who were rechallenged. Sera from all 14 patients contained antineutrophil cytoplasmic antibodies (ANCA) giving a perinuclear pattern on indirect immunofluorescence on ethanol-fixed human neutrophils (p-ANCA), whereas 14 control asymptomatic individuals taking minocycline for acne were ANCA-negative. Eleven of the 14 patients had elevated antimyeloperoxidase antibodies and 10 had antielastase antibodies on enzyme-linked immunosorbent assay, which diminished on extended follow-up, as did other serological abnormalities. Major histocompatibility complex class II typing demonstrated that all of the 13 patients tested were either HLA-DR4 (nine of 13) or HLA-DR2 (four of 13) positive, and all had an HLA-DQB1 allele encoding for tyrosine at position 30 of the first domain. Our findings suggest a model whereby the presence of p-ANCA may be a marker for the development of lupus-like symptoms in genetically susceptible individuals taking minocycline for acne.