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Case Series and Literature Review

Jonathan E. Teitelbaum, MD; Antonio R. Perez-Atayde, MD; Mark Cohen, MD; Athos Bousvaros, MD; Maureen M. Jonas, MD

Arch Pediatr Adolesc Med. 1998;152:1132-1136.

Background  Minocycline is an antibiotic commonly used in the treatment of adolescent acne.

Objectives  To describe the clinical, laboratory, and histological features in 3 cases of minocycline-related autoimmune hepatitis and to review the literature of similar cases in the adolescent population.

Design  Case series.

Setting  Patients were cared for in the Division of Gastroenterology, Children's Hospital, Boston, Mass.

Results  Three adolescents (age, 15-16 years), while being treated with therapeutic doses of minocycline for periods of 12 to 20 months, met the 1993 International Autoimmune Hepatitis Group criteria for autoimmune hepatitis. All had a positive antinuclear antibody titer. Other features included hypergammaglobulinemia and a positive anti–smooth muscle antibody titer. Two patients underwent liver biopsy that revealed severe chronic lymphoplasmacytic inflammation, necrosis, and fibrosis. 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 related to the development of autoimmune hepatitis in some adolescents. Pediatricians who use this drug for treatment of acne should be aware of this serious potential relation and stop the drug immediately when suspicion is raised.

Arch Pediatr Adolesc Med. 1998;152:1132-1136

From the Combined Program in Gastroenterology and Nutrition (Drs Teitelbaum, Bousvaros, and Jonas) and the Department of Pathology (Dr Perez-Atayde), Children's Hospital, Harvard Medical School, Boston, Mass; and Acton Medical Associates, Acton, Mass (Dr Cohen).

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