Palindromic Minocycline-Induced Vasculitis With Dual-Positivity for Myeloperoxidase Anti-neutrophil Cytoplasmic Antibody (MPO-ANCA) and Anti-DNA Antibody.

Long-term usage of minocycline can result in the development of various autoimmune conditions, including vasculitis. We herein report the case of a 23-year-old female patient who developed fever, arthralgia, and erythema of the lower limbs 15 months after the initiation of minocycline. Her symptoms recovered spontaneously within one and a half months but relapsed two months later along with dysesthesia of the lower limbs. Her myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) and anti-DNA antibody were positive, and histology of her skin demonstrated features of necrotizing vasculitis of the small vessels. Minocycline was discontinued, and her symptoms improved without requiring further treatment, along with the normalization of MPO-ANCA and anti-DNA antibody titers. No recurrence was observed nine months after discontinuation, although her lower limb dysesthesia lasted for six months before recovery. Clinicians should bear in mind the possibility of minocycline-induced vasculitis when symptoms of vasculitis are suspected in patients receiving long-term minocycline. An immediate withdrawal of the drug is recommended in such cases to prevent the development of organ-threatening lesions and long-lasting aftereffects.