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Antineutrophil cytoplasmic antibodies and HLA class II alleles in minocycline‐induced lupus‐like syndrome
Author(s) -
Dunphy J.,
Oliver M.,
Rands A.L.,
Lovell C.R.,
Mchugh N.J.
Publication year - 2000
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1046/j.1365-2133.2000.03357.x
Subject(s) - minocycline , medicine , systemic lupus erythematosus , immunology , human leukocyte antigen , serology , asymptomatic , autoantibody , connective tissue disease , anti neutrophil cytoplasmic antibody , antibody , lupus erythematosus , immunopathology , antigen , gastroenterology , autoimmune disease , vasculitis , biology , disease , antibiotics , genetics
We report 14 patients with minocycline‐induced lupus‐like syndrome (four men, 10 women; mean age 27·8 years) who developed a lupus‐like illness after chronic use of minocycline for acne (1–10 years, median 3·8). Clinical features resolved completely on drug withdrawal (mean follow‐up 11 months) and reappeared in two patients who were rechallenged. Sera from all 14 patients contained antineutrophil cytoplasmic antibodies (ANCA) giving a perinuclear pattern on indirect immunofluorescence on ethanol‐fixed human neutrophils (p‐ANCA), whereas 14 control asymptomatic individuals taking minocycline for acne were ANCA‐negative. Eleven of the 14 patients had elevated antimyeloperoxidase antibodies and 10 had antielastase antibodies on enzyme‐linked immunosorbent assay, which diminished on extended follow‐up, as did other serological abnormalities. Major histocompatibility complex class II typing demonstrated that all of the 13 patients tested were either HLA‐DR4 (nine of 13) or HLA‐DR2 (four of 13) positive, and all had an HLA‐DQB1 allele encoding for tyrosine at position 30 of the first domain. Our findings suggest a model whereby the presence of p‐ANCA may be a marker for the development of lupus‐like symptoms in genetically susceptible individuals taking minocycline for acne.