From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: QT3???
Date: 25 May 1999 06:36:58 GMT

In <374A12AB.B86234D9@servtech.com> Edward Mathes
<emathes@servtech.com> writes:
>
>> Great job.  (I really mean it)
>
>Thank you.
>
>> > She did not like the diagnosis so left the practice.
>>
>> What didn't she like about the diagnosis?  She just didn't like the
>> name of the disease, or she felt that the treatment wasn't as
>> effective as she had hoped, or she felt that it didn't explain all
>> of her symptoms?
>
>No. Believe it or not, she went to the internet, got a list of symptoms
>and disease description, decided she didn't fit all the nooks, so it
>could not possibly be FMF, and left. I think she is still looking for a
>diagnosis.
>
>I had another patinet (36 y/o F) who developed progressive arthralgias,
>hepatitis, and a lupus-like syndrome. Several weeks of testing,
>progressive symptoms, abnormal labs, several tests, CT scans, evaluation
>by a rheumatologist and a hepatologist, ready for a liver biopsy
>"tomorrow", came into the office because of new fever. Re-did her entire
>history. I asked about medications and she listed them. Finished with
>Minocin. Minocin. Started two years ago by derm for acne. Never bothered
>to tell anyone else about this medication ("I've been taking it so long I
>forgot!"). I had no indication in her chart that this antibiotic had been
>prescribed. Stopped the Minicin and the symptoms all resolved. BTW, this
>is a to-be-submitted-case report.....there are only 11 other similar
>cases in the literature for this combination of symptoms. But minocin is
>known to cause arthralgias and a lupus-like syndrome in certain people at
>around the two year mark. In any event, she got better! But her acne
>flaired so she restarted it! Guess what....symptoms reoccurred. SO I tell
>her, sorry, no more minocin! Here's why....and you just challenmged
>yourself. She left the practice because we should have known she was on
>minocin...and I agree....and she would not have been put thru 6-weeks of
>hell.


Comment:

   I didn't know that about Minocin/minocycline.  It's especially
interesting in that it's a very penetrative and powerful
antiinflammatory, sometimes acually useful in arthritis.  Prevents
chondral resorbtion.  My minocin side effect stories all involve the
much more common pseudotumor cerebri.  This nails female acne sufferers
preferentially (it's partly hormonal), and if they are on Acutane also,
forget it: they're practically bound to get it.  Doxycycline seems
somewhat less problematic all around, even though it too gets into
brain and fluid spaces reasonably well.  And is also an
antiinflammatory.  The reason these acne people don't get resistant to
this stuff is that it's actually not acting like an antibiotic.

   I did see a lupoid drug reaction the other day, but there was no
rash and it was just a pair of new monoarthridites-- right hip and
knee.  She had the hottest knee joint I've ever felt-- the thing was a
darn toaster-- but NO effusion and very little pain, except on
standing.  Following the FTC theory (first think drugs) I suspected the
hydralazine started a month before.  Which we'd put her one because the
minoxidil was making her grow hair out of her face like the wolfman.
Which got started because the ACE inhibitor made her creatinine go from
2 to 2.5, and some renal fellow stopped THAT.  To make a long story
short her ANA was 160.  Took her off the drug and arthritis
disappeared--- I didn't even tap it.  ANA titer went back to normal.
Put her back on the ACE inhibitor.  Not going to send her back to the
renal service at all, poor lady.  A renal doc I respect says a bump of
5 is bearable.  Especially with the stuff we've had to put up with as
alternatives!