A 39-year-old woman was evaluated for possible
liver transplantation due to rapidly developing
hepatic failure 4 weeks after initiation of oral
minocycline 100 mg twice a day for the treatment of
acne. The patient developed a maculopapular
rash, malaise,
fever,
nausea, and
vomiting 2 weeks prior to admission to the hospital. On admission, her symptoms rapidly progressed to
liver failure characterized by rapidly rising liver
enzyme levels, worsening
encephalopathy, and coagulopathy. Viral
hepatitis serologies and blood cultures were all negative. After intensive supportive care for 2 weeks, the patient's condition gradually improved and she was discharged with mildly elevated liver
enzyme levels and
pruritus, without need of
liver transplantation.
Minocycline-induced hepatic injury is an idiosyncratic reaction with a sensitization period that appears to be 3-4 weeks in duration. The characteristic features include
rash,
fever,
lymphadenopathy, and
eosinophilia, as well as severe alterations in liver function. The high liver
enzyme levels and the significant prolongation of the prothrombin time suggest massive hepatocellular damage. In light of the profound liver damage that occurs with this adverse reaction, care should be taken in administering
minocycline to patients who have concomitant
liver disease. It is recommended that patients should be instructed as to the possible signs and symptoms of toxicity and be monitored for evidence of idiosyncratic reaction or
liver failure.