Contribution of HLA-DRB1 * 09: 01 allele to development of minocycline induced antineutrophil cytoplasmic antibody (ANCA)-associated cutaneous vasculitis: report of two cases. (2nd July 2020)

• Record Type: Journal Article
• Authors: Kawahara, Hiroyuki; Nakashima, Akikatsu; Zoshima, Takeshi; Kawano, Mitsuhiro
• Is Part Of: Modern rheumatology case reports. Volume 4:Number 2(2020)
• Page Start: 267
• Page End: 271
• Publication Date: 2020-07-02
• Subjects: HLA-DRB1 * 09: 01 -- drug-associated vasculitis -- minocycline -- antineutrophil cytoplasmic antibodies (ANCA) -- cutaneous vasculitis; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1080/24725625.2020.1738983
• Languages: English
• ISSNs: 2472-5625

Abstract

Abstract: We report two cases of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) that developed after long-term oral administration of minocycline and consider the contribution of human leukocyte antigen (HLA)-DRB 1 * 09: 01 allele to its development. Case 1; A 47-year-old man receiving minocycline for palmoplantar pustulosis for 24 months developed fever, arthralgia, and irregular livedo on the bilateral lower legs. Skin biopsy demonstrated vasculitis, while a blood test showed positivity of myeloperoxidase (MPO)-ANCA. Discontinuation of minocycline and oral administration of prednisolone relieved the symptoms promptly. Case 2; A 53-year-old woman developed reddish-brown livedo reticularis with tenderness on the bilateral lower legs after administration of minocycline to treat palmoplantar pustulosis for 24 months. Although skin biopsy did not demonstrate vasculitis, a blood test showed MPO-ANCA positivity. Cessation of minocycline resulted in rapid improvement of the cutaneous lesions and constitutional symptoms. We diagnosed both cases as having Drug-associated ANCA-associated Vasculitis (DAV) caused by minocycline according to the diagnostic criteria proposed by Cluver et al. Further examination revealed the presence of HLA-DRB1 * 09:01 allele in both cases. This allele has been implicated in the genetic background of idiopathic microscopic polyangiitis (MPA) in the Japanese population. Our finding suggests a relationship between the development of MPO-ANCA or DAV caused by minocycline and HLA-DRB1 * 09:01 allele, but will have to confirmed by further studies with larger numbers of patients.