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A 80 years old lady came to our attention in February 2007 due to dysphagia and increase of liver enzymes (AST 194 U/L, ALT 308 U/L). She had been treated with minocycline, 100 mg/day, from February 2005 to March 2006, for perioral dermatitis. Upper endoscopy revealed a rabbit-bone impacted in the proximal third of the esophagus, removed with grasping forceps. Serological markers for hepatitis were negative; mild anemia (Hb 12.8 g/dl) and leukopenia (3.300/mmc) with a modest increase of gammaglobulines (20.4%) were noted. Anti-nuclear antibodies were present (1:160, homogenous pattern) while anti-mitochondrial, anti-liver-kidney and anti-endomysial antibodies were negative. No Ig deficit was present. The patient was discharged with a follow-up program. After one month, liver enzymes increased (AST 652 U/L, ALT 721 U/L, GGT 107 U/L), as well as anti-nuclear antibodies (1:320), and the liver function was mildly impaired (prothrombin time 75% with INR of 1.22, bilirubin level 2.2 mg/dl with direct bilirubin 0.7 mg/dl, cholinesterases 4939 U/L). Liver biopsy revealed intact lobular architecture with diffuse dilation of portal spaces, inflammatory infiltrate prevalently represented by lymphocytes and monocytes, and septs development. Ductular degeneration area, focal cholangytis, severe piece-meal necrosis, several areas of lobular necrosis (zone 3) and perivenular necrosis with portal-central bridges were found (Fig. 1). Prednisone, 50 mg/day, was started with a low tapering schedule and, after one year, the patient showed a complete normalization of liver enzymes. In June 2008, steroid therapy was stopped and the patient is presently enjoying good health.

Acute hepatitis caused by minocycline