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Vasculitic neuropathy following exposure to minocycline.

Baratta JM, Dyck PJ, Brand P, Thaisetthawatkul P, Dyck PJ, Engelstad JK, Goodman B, Karam C - Neurol Neuroimmunol Neuroinflamm (2015)

Bottom Line: Symptoms developed with either early or prolonged use of minocycline.Despite withdrawal of minocycline, patients needed long-term immunotherapy to gain neurologic improvement.Our findings suggest that the typical neuropathy associated with minocycline use is painful single or multiple mononeuropathy due to peripheral nerve vasculitis, which may also be accompanied by presumed CNS vasculitis (presenting as stroke).

View Article: PubMed Central - PubMed

Affiliation: Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ.

ABSTRACT

Objective: To report 3 patients with minocycline-induced autoimmunity resulting in peripheral nerve vasculitis.

Methods: We report 3 patients who, during minocycline treatment for acne vulgaris, developed subacute onset of pain and weakness caused by vasculitis in single and multiple mononeuropathy patterns.

Results: Each patient underwent either a nerve or muscle biopsy that confirmed vasculitis. One patient additionally developed systemic symptoms (including fever, fatigue, and night sweats) and another had a posterior circulation stroke. Symptoms developed with either early or prolonged use of minocycline. Despite withdrawal of minocycline, patients needed long-term immunotherapy to gain neurologic improvement.

Conclusions: Our findings suggest that the typical neuropathy associated with minocycline use is painful single or multiple mononeuropathy due to peripheral nerve vasculitis, which may also be accompanied by presumed CNS vasculitis (presenting as stroke).

No MeSH data available.


Related in: MedlinePlus

Patient 1 radial nerve biopsy(A) Hematoxylin & eosin stain of radial nerve demonstrates epineurial nerve large arteriole necrotizing vasculitis. Note the prominent inflammatory cell infiltrate infiltrating and disrupting all layers of the arteriolar wall and the fibrinoid necrosis (arrows). (B) Methylene blue stain of radial nerve demonstrates myelinated fiber degeneration in the center of the fascicle that is typical of ischemic changes (outlined).
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Figure 1: Patient 1 radial nerve biopsy(A) Hematoxylin & eosin stain of radial nerve demonstrates epineurial nerve large arteriole necrotizing vasculitis. Note the prominent inflammatory cell infiltrate infiltrating and disrupting all layers of the arteriolar wall and the fibrinoid necrosis (arrows). (B) Methylene blue stain of radial nerve demonstrates myelinated fiber degeneration in the center of the fascicle that is typical of ischemic changes (outlined).

Mentions: Subsequent brain MRI showed an acute right medial medullary ischemic stroke. Extensive evaluation did not reveal a hypercoagulable state, embolic source, or large artery abnormality. Nerve conduction studies and needle EMG showed diffuse abnormalities within all limbs, which were asymmetric and suggestive of an axonal multiple mononeuropathy or asymmetrical polyradiculoneuropathy. Left upper extremity findings localized to the brachial plexus or multiple peripheral nerves. A brachial plexus MRI showed generalized increased T2 signal intensity throughout the course the left brachial plexus. Antinuclear antibody (ANA) was mildly positive (1:160) and C-reactive protein was elevated (18.4). CSF analysis was normal. Autoimmune and infectious workups were otherwise negative. A left superficial radial nerve biopsy was consistent with necrotizing vasculitis (figure 1).


Vasculitic neuropathy following exposure to minocycline.

Baratta JM, Dyck PJ, Brand P, Thaisetthawatkul P, Dyck PJ, Engelstad JK, Goodman B, Karam C - Neurol Neuroimmunol Neuroinflamm (2015)

Patient 1 radial nerve biopsy(A) Hematoxylin & eosin stain of radial nerve demonstrates epineurial nerve large arteriole necrotizing vasculitis. Note the prominent inflammatory cell infiltrate infiltrating and disrupting all layers of the arteriolar wall and the fibrinoid necrosis (arrows). (B) Methylene blue stain of radial nerve demonstrates myelinated fiber degeneration in the center of the fascicle that is typical of ischemic changes (outlined).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4645168&req=5

Figure 1: Patient 1 radial nerve biopsy(A) Hematoxylin & eosin stain of radial nerve demonstrates epineurial nerve large arteriole necrotizing vasculitis. Note the prominent inflammatory cell infiltrate infiltrating and disrupting all layers of the arteriolar wall and the fibrinoid necrosis (arrows). (B) Methylene blue stain of radial nerve demonstrates myelinated fiber degeneration in the center of the fascicle that is typical of ischemic changes (outlined).
Mentions: Subsequent brain MRI showed an acute right medial medullary ischemic stroke. Extensive evaluation did not reveal a hypercoagulable state, embolic source, or large artery abnormality. Nerve conduction studies and needle EMG showed diffuse abnormalities within all limbs, which were asymmetric and suggestive of an axonal multiple mononeuropathy or asymmetrical polyradiculoneuropathy. Left upper extremity findings localized to the brachial plexus or multiple peripheral nerves. A brachial plexus MRI showed generalized increased T2 signal intensity throughout the course the left brachial plexus. Antinuclear antibody (ANA) was mildly positive (1:160) and C-reactive protein was elevated (18.4). CSF analysis was normal. Autoimmune and infectious workups were otherwise negative. A left superficial radial nerve biopsy was consistent with necrotizing vasculitis (figure 1).

Bottom Line: Symptoms developed with either early or prolonged use of minocycline.Despite withdrawal of minocycline, patients needed long-term immunotherapy to gain neurologic improvement.Our findings suggest that the typical neuropathy associated with minocycline use is painful single or multiple mononeuropathy due to peripheral nerve vasculitis, which may also be accompanied by presumed CNS vasculitis (presenting as stroke).

View Article: PubMed Central - PubMed

Affiliation: Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ.

ABSTRACT

Objective: To report 3 patients with minocycline-induced autoimmunity resulting in peripheral nerve vasculitis.

Methods: We report 3 patients who, during minocycline treatment for acne vulgaris, developed subacute onset of pain and weakness caused by vasculitis in single and multiple mononeuropathy patterns.

Results: Each patient underwent either a nerve or muscle biopsy that confirmed vasculitis. One patient additionally developed systemic symptoms (including fever, fatigue, and night sweats) and another had a posterior circulation stroke. Symptoms developed with either early or prolonged use of minocycline. Despite withdrawal of minocycline, patients needed long-term immunotherapy to gain neurologic improvement.

Conclusions: Our findings suggest that the typical neuropathy associated with minocycline use is painful single or multiple mononeuropathy due to peripheral nerve vasculitis, which may also be accompanied by presumed CNS vasculitis (presenting as stroke).

No MeSH data available.


Related in: MedlinePlus