Abstract
BackgroundHypersentivity Syndrome (HS) may be a life-threatening condition. It frequently presents with fever, rash, eosinophilia and systemic manifestations. Mortality can be as high as 10% and is primarily due to hepatic failure. We describe what we believe to be the first case of minocycline-induced HS with accompanying lymphocytic meningitis and cerebral edema reported in the literature.Case presentationA 31-year-old HIV-positive female of African origin presented with acute fever, lymphocytic meningitis, brain edema, rash, eosinophilia, and cytolytic hepatitis. She had been started on minocycline for inflammatory acne 21 days prior to the onset of symptoms. HS was diagnosed clinically and after exclusion of infectious causes. Minocycline was withdrawn and steroids were administered from the second day after presentation because of the severity of the symptoms. All signs resolved by the seventh day and steroids were tailed off over a period of 8 months.ConclusionClinicians should maintain a high index of suspicion for serious adverse reactions to minocycline including lymphocytic meningitis and cerebral edema among HIV-positive patients, especially if they are of African origin. Safer alternatives should be considered for treatment of acne vulgaris. Early recognition of the symptoms and prompt withdrawal of the drug are important to improve the outcome.
Highlights
Hypersentivity Syndrome (HS) may be a life-threatening condition
Mortality may be as high as 10% and is primarily due to hepatic failure [2]
Lymphocytic meningitis and brain edema associated with minocycline-induced HS have not been reported in the literature
Summary
Hypersentivity Syndrome (HS) is a rare and life-threatening form of drug reaction [1]. Lymphocytic meningitis and brain edema associated with minocycline-induced HS have not been reported in the literature. This presentation, which is probably under-recognized, may lead to a diagnostic delay. Three weeks before the onset of the symptoms, she had been started on oral minocycline to control an inflammatory form of acne vulgaris. At admittance she was unwell and vital signs were: blood pressure 100/60, temperature 40°C, heart rate 120 beats/ min., respiratory rate 22/min., and oxygen saturation 97% (room air). The patient was weaned off steroids over a period of 8 months and was free of symptoms at discharged form care
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