Minocycline-Induced Acute Eosinophilic Pneumonia: Controversial Results of Lymphocyte Stimulation Test and Re-challenge Test

• Published in: Internal Medicine Vol. 46; no. 9; pp. 593 - 595
• Main Authors: Ono, Emiko, Miyazaki, Eishi, Matsuno, Osamu, Nureki, Shin-ichi, Okubo, Toshiyuki, Ando, Masaru, Kumamoto, Toshihide
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.01.2007
• Subjects: acetaminophen; Acetaminophen - adverse effects; Acute Disease; acute eosinophilic pneumonia; Analgesics, Non-Narcotic - adverse effects; Anti-Bacterial Agents - adverse effects; False Negative Reactions; False Positive Reactions; Female; Humans; Hypoxia - chemically induced; Immunologic Techniques - standards; Lymphocyte Activation; lymphocyte stimulating test; Middle Aged; minocycline; Minocycline - adverse effects; Pulmonary Eosinophilia - chemically induced; Pulmonary Eosinophilia - diagnostic imaging; Radiography, Thoracic; re-challenge test; Tomography, X-Ray Computed
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.46.6235

We report an instructive case of minocycline-induced eosinophilic pneumonia confirmed by re-challenge test, in which a preceding lymphocyte-stimulation test indicated acetaminophen as the etiologic agent. A 55-year-old woman developed high fever and lung infiltrates with pulmonary eosinophilia after exposure to minocycline, acetaminophen, theophylline and procaterol. All of the medicines were discontinued, resulting in prompt improvement. The lymphocyte stimulation tests provided a positive result for acetaminophen, but not for the other medicines; however, a negative result was given by a re-challenge test with acetaminophen. In contrast, symptoms and hypoxemia reappeared when minocycline was re-administered. We would like to emphasize that lymphocyte stimulation test results need to be carefully interpreted for individual drugs.