Acute Liver Failure Following Minocycline Treatment – A Case Report and Review of the Literature

Abstract

We present the case of a 23-year-old female patient with acute liver failure following intake of minocycline. This patient had severe hypereosinophilia and massively increased IgE levels. Experimental studies in this case revealed elevated IFN-γ-, as well as TNF-α-producing CD4⁺ and CD8⁺ T-cells after in vitro stimulation with minocycline, indicating a type I/IgE-mediated as well as type II/cytotoxic reaction in the pathogenesis of minocycline-induced liver failure. Although mild forms of liver involvement are well known side effects of minocycline, only 8 cases with acute liver failure have been reported, and we present a review of all cases.

Zusammenfassung

Wir präsentieren den Fall einer 23-jährigen Patientin mit akutem Leberversagen nach Einnahme von Minocyclin. Die Patientin zeigte eine schwere Eosinophilie und ein massiv erhöhtes IgE. In-vitro-Versuche mit mononukleären Zellen aus dem Blut der Patientin ergaben erhöhte IFN-γ und TNF-α produzierende CD4^+- und CD8⁺ T-Zellen nach Stimulation mit Minocyclin und damit sowohl eine Typ-I-/IgE-vermittelte als auch eine Typ II/zytotoxische Reaktion in der Pathophysiologie des Minocyclin-induzierten akuten Leberversagens. Obwohl leichte Formen der Leberbeteiligung nach Einnahme von akutem Leberversagen gut bekannt sind, wurden bislang nur 8 Fälle von akutem Leberversagen dokumentiert und wir präsentieren eine Zusammenschau aller Fälle.

Key words

acute liver failure - minocycline - immune-mediated type I reaction - acne

Schlüsselwörter

akutes Leberversagen - Minocyclin - Typ-I-/IgE-vermittelte Reaktion - Akne

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