MINOCYCLINE-RELATED AUTOIMMUNE HEPATITIS - CASE SERIES AND LITERATURE-REVIEW

Background: Minocycline is an antibiotic commonly used in the treatmen t of adolescent acne. Objectives: To describe the clinical, laboratory , and histological features in 3 cases of minocycline-related autoimmu ne hepatitis and to review the literature of similar cases in the adol escent population. Design: Case series. Setting: Patients were cared f or in the Division of Gastroenterology, Children's Hospital, Boston, M ass. Results: Three adolescents (age, 15-16 years), while being treate d with therapeutic doses of minocycline for periods of 12 to 20 months , met the 1993 international Autoimmune Hepatitis Group criteria for a utoimmune hepatitis. All had a positive antinuclear antibody titer. Ot her features included hypergammaglobulinemia and a positive anti-smoot h muscle antibody titer. Two patients underwent liver biopsy that reve aled severe chronic lymphoplasmacytic inflammation, necrosis, and fibr osis. 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. Conclusions: Minocycline is rela ted to the development of autoimmune hepatitis in some adolescents. Pe diatricians who use this drug for treatment of acne should be aware of this serious potential relation and stop the drug immediately when su spicion is raised.