Education And Debate

Lesson of the Week: Minocycline and pulmonary eosinophilia

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6993.1520 (Published 10 June 1995) Cite this as: BMJ 1995;310:1520
  1. R S Dykhuizen, registrara,
  2. A M Zaidi, registrarb,
  3. D J Godden, lecturera,
  4. S Jegarajah, consultant physicianb,
  5. J S Legge, consultant chest physiciana
  1. a Department of Thoracic Medicine, City Hospital, Aberdeen AB9 8AU
  2. b Department of Medicine, Birch Hill Hospital, Rochdale OL12 8HS
  1. Correspondence to: Dr Dykhuizen.
  • Accepted 9 December 1994

Minocycline hydrochloride, a semisynthetic tetracycline derivative, is often prescribed by general practitioners and dermatologists for acne vulgaris in young people. It is also useful in treating bronchopulmonary and urinary tract infections. Longstanding familiarity with the drug has established its relative safety.1 Adverse effects that have been reported are nausea, fever, blood eosinophilia, vestibular symptoms, skin rashes, photosensitivity, and hyperpigmentation. Minocycline is known to cause tooth discoloration in the fetus and is contraindicated during pregnancy and in childhood up to the age of 8 years.

We report on four patients who became unwell with fevers and pulmonary eosinophilia while receiving minocycline for acne.

Case reports

CASE 1

One week after starting Minocin MR (Lederle Laboratories, UK) 100 mg once a day for facial acne, a 36 year old woman presented with fevers, cough, shortness of breath on exertion, and weight loss. A chest radiograph showed bilateral infiltration, and her blood eosinophil count was 1.3 x 109/l (14%). IgE in the blood measured 807 IU/l, with specific IgE against house dust mite only. Tests for antinuclear factor, antineutrophil cytoplasmic antibody, and aspergillus precipitins had negative results. The sputum contained large clumps of eosinophils with numerous Charcot-Leyden crystals. The patient was treated with 30 mg prednisolone once a day for 10 days, and minocycline was discontinued. After three weeks the patient was asymptomatic with a normal chest radiograph and eosinophil count. Rechallenge (with informed consent) resulted in a prompt recurrence of symptoms, chest …

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