Sixty-five case reports were included in the review.
Autoimmune hepatitis (n=29).
Cases were generally associated with a prolonged course of minocycline therapy (the median was 365 days for females and 730 days for males), the presence of autoantibodies (90%) and symptoms of arthritis and/or arthralgia (72%). Recovery on complete cessation of the drug was apparent for all patients in a mean of 14 days (range: 4 - 38). Five patients experienced a recurrence of symptoms in response to re-challenge with minocycline.
Hypersensitivity reactions (n=16).
The condition was typically associated with eosinophilia (69% of patients) and desquamation of the skin (63%). The duration of treatment with minocycline before onset was less than 35 days in all cases. Three patients died from what appeared to be a hypersensitivity reaction, and one patient received a liver transplantation and survived.
Unspecified hepatitis (n=20).
The duration of treatment with minocycline ranged from 8 to 360 days for females and 9 to 840 days for males. One patient died and another received a liver transplantation and survived. One case experienced a resumption of symptoms on re-exposure to minocycline.
The WHO has recorded 8,025 reactions to minocycline overall, 6% of these involved the liver. The outcome of these reactions was reported in less than half the cases. Three deaths were evident.