Case Report: A 40-Year-Old Man with Vasculitic Neuropathy

Conclusion

We present an unusual case of a 40-year-old who had been taking minocycline for three years to treat acne vulgaris. He developed acute, bilateral, lower extremity mononeuritis multiplex-associated vasculitis meeting the ACR criteria for PAN.¹⁹ As with minocycline-
associated systemic lupus and autoimmune hepatitis and other drug-induced auto­immune diseases, a high index of suspicion and prompt removal of the offending agent is key to clinical remission.

Similarities between our case and cases of minocycline-associated primary vasculitic neuropathy found in the literature may assist with this recognition (see Table 3). Almost all cases involved the long-term (two years on average) use of minocycline for acne vulgaris. Skin manifestations, including livedo reticularis and purpuric papules, were present in our patient and common in the cases previously reported, as were symptoms of generalized arthralgias and myalgias.

Table 3: Common Features of Minocycline-Associated Vasculitis

Our case and those reviewed underscore the importance of recognizing the association of positive ANA and P-ANCA tests with long-term minocycline use. Long-term immunosuppressive treatment is not necessary for these patients. All patients reported in the literature responded quickly (within four to 12 weeks) to withdrawal of minocycline. 

Martin Garber, DO, is a lecturer in the Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor. He is also an instructor in internal medicine in the Division of Rheumatology at the University of Michigan Medical School.

David Fivenson, MD, is the director of Fivenson Dermatology, Ann Arbor, Mich.

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Authors’ note: Special thanks to John Sherbeck, MD, Department of Pathology, St. Joseph Mercy Hospital, Ann Arbor, Mich.