Primum non nocere: Minocycline‐induced liver injury in a teenager

• Published in: Journal of paediatrics and child health Vol. 54; no. 9; pp. 1031 - 1033
• Main Authors: Shankar, Sahana, Oliver, Mark R
• Format: Journal Article
• Language: English
• Published: Australia John Wiley & Sons Australia, Ltd 01.09.2018; Blackwell Publishing Ltd
• Subjects: Acne; Adolescent; Anti-Bacterial Agents - administration & dosage; Antibiotics; Case reports; Chemical and Drug Induced Liver Injury, Chronic - diagnosis; Chemical and Drug Induced Liver Injury, Chronic - drug therapy; Diagnosis, Differential; Drug therapy; Female; Humans; Injuries; Liver; Medical diagnosis; Minocycline - administration & dosage; Pediatrics; Side effects; Teenagers; Treatment Outcome; Australia
• ISSN: 1034-4810; 1440-1754
• DOI: 10.1111/jpc.14096

A 15‐year‐old girl presented with 8‐day history of fever, rash and abdominal pain. She did not report any localising symptoms, jaundice or bleeding or altered sensorium. On enquiry, she reported treatment with minocycline 50 mg twice daily for acne for 4 weeks prior to onset of illness, and she experienced symptoms a couple of days after cessation of minocycline. This also coincided with a vacation in Northern Queensland. Her past medical history was unremarkable, and her immunisations were up‐to‐date. On examination, she looked unwell and was febrile and tachycardic but normotensive. She had a generalised erythematous maculopapular rash (Fig. 1) with few petechiae. She was anicteric with cervical and axillary lymphadenopathy but had no peripheral oedema or stigmata of chronic liver disease. Abdominal examination revealed tender hepatomegaly with a palpable left lobe and an enlarged spleen. There was some free fluid as evidenced by bilateral flank dullness. The rest of her physical examination was unremarkable.