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Minocycline Pneumonitis and EosinophiliaA Report on Eight Patients
Olivier Sitbon, MD;
Nathalie Bidel;
Christine Dussopt, MD;
Réza Azarian, MD;
Marie Laure Braud, MD;
François Lebargy, MD;
Thierry Fourme, MD;
Frédéric de Blay, MD;
Françoise Piard, MD;
Philippe Camus, MD
Arch Intern Med. 1994;154(14):1633-1640.
Abstract
We identified eight patients (six women and two men) who had pulmonary infiltrates during treatment with minocycline hydrochloride between 1989 and 1992 in French referral centers for drug-induced pulmonary diseases. Clinical files, chest roentgenograms, computed tomographic scans, pulmonary function, and bronchoalveolar lavage data were reviewed. Minocycline treatment was given for acne (n=4), genital infection (n=3), and Lyme disease (n=1). The duration of treatment averaged 13±5 days (mean±SE); the total dose, 2060±540 mg. Patients presented with dyspnea (n=8), fever (n=7), dry cough (n=5), hemoptysis (n=1), chest pain (n=2), fatigue (n=3), and rash (n=3). Chest roentgenograms showed bilateral infiltrates in all cases. Pulmonary function was measured in five patients; four had airflow obstruction and two had mild restriction. Blood gas tests demonstrated hypoxemia in seven patients (58±3 mm Hg). Seven patients had blood eosinophilia (1.76±0.2x109/L). Bronchoalveolar lavage (performed in seven patients) showed an increased proportion of eosinophils (0.30±0.07). The CD4+/ CD8+ ratio was determined in four cases and was low in three. Transbronchial lung biopsy, performed in two patients, showed interstitial pneumonitis in both patients, with marked infiltration by eosinophils in one patient. The outcome was favorable in all patients. Because of severe symptoms, steroid therapy was required in three patients. Rechallenge was not attempted. We conclude that minocycline can induce the syndrome of pulmonary infiltrates and eosinophilia, that presenting symptoms may be severe and may culminate in transient respiratory failure, and that the disease has a favorable prognosis. (Arch Intern Med. 1994;154:1633-1640)
Author Affiliations
From the Service de Pneumologie et de Réanimation Respiratoire, Hôpital Antoine Béclère, Université Paris-Sud, Clamart (Drs Sitbon and Azarian), Unité de Pneumologie, Service de Médecine Interne et Maladies Infectieuses, Hôpital Universitaire de Bicêtre, Le Kremlin-Bicêtre (Dr Sitbon), Service de Pneumologie et de Réanimation Respiratoire, Centre Hospitalier Universitaire, Faculté de Médecine, and Université de Bourgogne, Dijon (Ms Bidel and Dr Camus), Service de Broncho-Pneumologie, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon (Dr Dussopt), Service de Pneumologie, Centre Hospitalier, Bourg-en-Bresse (Dr Braud), Unité de Pneumologie, Hôpital Henri Mondor, Créteil (Dr Lebargy), Service de Réanimation Polyvalente, Hôpital A. Paré, Boulogne (Dr Fourme), Service de Pneumologie, Centre Hospitalier Régional et Universitaire, Strasbourg (Dr de Blay), and Service d'Anatomie Pathologique, Centre Hospitalier Universitaire and Université de Bourgogne (Dr Piard), France.
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