FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4248066458> ?p ?o ?g. }

• W4248066458 endingPage "1" @default.
• W4248066458 startingPage "1" @default.
• W4248066458 abstract "A 17-year-old man was evaluated in the emergency department with a 1-day history of binocular oblique diplopia present only at distance. He denied head trauma, as well as blurry vision, ocular pain, numbness, weakness, paresthesias, dysphagia, or difficulty breathing. He had no recent illness, denied drug, or alcohol use and had no history of strabismus. He did report right-sided ptosis, presumably due to traumatic levator dehiscence from participating in multiple contact sports. The ptosis developed 18 months previously and was surgically repaired 6 months before the onset of diplopia. His medical history included inflammatory acne for which he was taking benzaclin 5% gel daily, minocycline 100 mg twice daily, sulfacetamide sodium-sulfur 10-5% cleanser daily and tretinoin 0.1% cream daily. On examination, his visual acuity was 20/20 in each eye with limited adduction, supraduction, and infraduction of the left eye. Ocular motility of the right eye was normal. His color vision was intact in both eyes. His pupils in the dark were 6 and 7 mm in the right and left eyes, respectively, and the degree of anisocoria did not change in the light. On lid evaluation, his mean pupillary reflex distance was +3 mm in both eyes, and the appearance of the anterior and posterior segments of each eye was unremarkable. A diagnosis of a possible pupil-involving third nerve palsy was made, and the patient underwent computed tomography angiography of his head and neck. These studies were unremarkable. Brain MRI revealed a 5- to 6-mm left midbrain lesion, most consistent with an ischemic etiology (Fig. 1). Complete blood count, sedimentation rate, and C-reactive protein were normal. Transaminases were elevated: aspartate aminotransferase 74 U/L (normal: 8–48 U/L) and alanine aminotransferase 110 U/L (normal: 7–55 U/L). Antineutrophil cytoplasmic antibody (ANCA) testing was positive with a perinuclear pattern (p-ANCA) with antimyeloperoxidase (MPO) antibodies at 1.2 U (normal <1/0 U). Lupus antibodies including anti-Smith and antiphospholipid antibodies were negative. Lumbar puncture revealed an opening pressure of 170 mm H2O, and cerebrospinal fluid (CSF) testing was negative for syphilis, tuberculosis, cytomegalovirus, Epstein–Barr virus, herpes simplex 1 and 2, and varicella zoster virus. There was a mildly elevated protein level of 40 mg/dL (0–35 mg/dL), normal glucose, 11 cells/mL, with a lymphocytic predominance and no oligoclonal bands. NMO-IgG4 and a complete CSF paraneoplastic panel, including GAD65 antibodies, were negative. The laboratory and imaging findings were consistent with minocycline-induced p-ANCA–positive vasculitis resulting in midbrain ischemia and a third nerve palsy.FIG. 1.: Axial diffusion-weighted imaging shows a hyperintensity within the left midbrain (arrow) (A), which is consistent with restricted diffusion (arrow) on the apparent diffusion coefficient map (B).Minocycline was discontinued, and the patient was treated with aspirin 325 mg daily and a 2-month taper of oral prednisone beginning at 60 mg daily. Six weeks after initial presentation, the patient's diplopia had resolved, and follow-up MRI was normal. One year later, the p-ANCA levels returned to the normal range, and the patient was maintained on 81 mg of aspirin daily. Minocycline is known to cause autoimmune conditions such as drug-induced systemic lupus erythematosus and autoimmune hepatitis, whereas vasculitis is less common (1,2). There are several reports of a minocycline-associated cutaneous vasculitis resulting in livedo reticularis and hyperpigmented subcutaneous nodules, but few reports of systemic vasculitis (3). The vasculitis associated with minocycline is typically characterized as similar to polyarteritis nodosa (PAN), being both p-ANCA– and ANA-positive. It is believed that, in this PAN-like vasculitis, minocycline induces an autoimmune response directed against neutrophil enzymes resulting in anti-MPO antibodies. However, anti-MPO antibodies may be negative, suggesting the presence of other antigens such as elastase or other enzymes that are not often tested clinically (4). Antibody–antigen complexes can then lead to a thrombotic microangiopathy resulting in a systemic vasculitis and vascular occlusions or, as in our patient, an ischemic brainstem infarction leading to a third nerve palsy (1). There have been reports of a minocycline-induced PAN-like vasculitis resulting in ischemic strokes within the posterior circulation (1,4). One of these publications included a patient with lymphocytic-predominant mild pleocytosis in the CSF, possibly an indicator of CNS vasculitis. The median time of minocycline use in a case series of 9 patients with minocycline-induced vasculitis was 2 years with a minimum of 1 year (3), although there has been a case report of PAN-like vasculitis occurring 8 months after initiation of minocycline (5). Our patient was taking minocycline for 2.5 years before presentation. The treatment of minocycline PAN-like vasculitis includes cessation of the drug coupled with the use of either oral or intravenous steroids. In some instances, there may be the need for a steroid-sparing agent (3). Patients tend to respond well to the cessation of minocycline, but symptoms and signs will recur with rechallenge of the drug (5). STATEMENT OF AUTHORSHIP Category 1: a. conception and design: M. R. Starr, J.-M. Tillema, S. R. Ytterberg, M. T. Bhatti, and J. J. Chen; b. acquisition of data: M. R. Starr; c. analysis and interpretation of data: M. R. Starr, J.-M. Tillema, S. R. Ytterberg, M. T. Bhatti, and J. J. Chen. Category 2: a. drafting the manuscript: M. R. Starr; b. revising it for intellectual content: M. R. Starr, J.-M. Tillema, S. R. Ytterberg, M. T. Bhatti, and J. J. Chen. Category 3: a. final approval of the completed manuscript: M. R. Starr, J.-M. Tillema, S. R. Ytterberg, M. T. Bhatti, and J. J. Chen." @default.
• W4248066458 created "2022-05-12" @default.
• W4248066458 creator A5005798516 @default.
• W4248066458 creator A5012718828 @default.
• W4248066458 creator A5032270668 @default.
• W4248066458 creator A5063680939 @default.
• W4248066458 creator A5064919549 @default.
• W4248066458 date "2018-12-01" @default.
• W4248066458 modified "2023-09-27" @default.
• W4248066458 title "Minocycline-Induced Vasculitis Presenting as a Third Nerve Palsy" @default.
• W4248066458 doi "https://doi.org/10.1097/00041327-900000000-99192" @default.
• W4248066458 hasPublicationYear "2018" @default.
• W4248066458 type Work @default.
• W4248066458 citedByCount "0" @default.
• W4248066458 crossrefType "journal-article" @default.
• W4248066458 hasAuthorship W4248066458A5005798516 @default.
• W4248066458 hasAuthorship W4248066458A5012718828 @default.
• W4248066458 hasAuthorship W4248066458A5032270668 @default.
• W4248066458 hasAuthorship W4248066458A5063680939 @default.
• W4248066458 hasAuthorship W4248066458A5064919549 @default.
• W4248066458 hasBestOaLocation W42480664581 @default.
• W4248066458 hasConcept C118487528 @default.
• W4248066458 hasConcept C141071460 @default.
• W4248066458 hasConcept C142724271 @default.
• W4248066458 hasConcept C204787440 @default.
• W4248066458 hasConcept C2778097013 @default.
• W4248066458 hasConcept C2778257484 @default.
• W4248066458 hasConcept C2780581723 @default.
• W4248066458 hasConcept C2781194658 @default.
• W4248066458 hasConcept C71924100 @default.
• W4248066458 hasConceptScore W4248066458C118487528 @default.
• W4248066458 hasConceptScore W4248066458C141071460 @default.
• W4248066458 hasConceptScore W4248066458C142724271 @default.
• W4248066458 hasConceptScore W4248066458C204787440 @default.
• W4248066458 hasConceptScore W4248066458C2778097013 @default.
• W4248066458 hasConceptScore W4248066458C2778257484 @default.
• W4248066458 hasConceptScore W4248066458C2780581723 @default.
• W4248066458 hasConceptScore W4248066458C2781194658 @default.
• W4248066458 hasConceptScore W4248066458C71924100 @default.
• W4248066458 hasLocation W42480664581 @default.
• W4248066458 hasLocation W42480664582 @default.
• W4248066458 hasOpenAccess W4248066458 @default.
• W4248066458 hasPrimaryLocation W42480664581 @default.
• W4248066458 hasRelatedWork W1933547075 @default.
• W4248066458 hasRelatedWork W1979357679 @default.
• W4248066458 hasRelatedWork W2007853957 @default.
• W4248066458 hasRelatedWork W2045149083 @default.
• W4248066458 hasRelatedWork W2076080869 @default.
• W4248066458 hasRelatedWork W2402297150 @default.
• W4248066458 hasRelatedWork W2413242661 @default.
• W4248066458 hasRelatedWork W2963565512 @default.
• W4248066458 hasRelatedWork W2963934427 @default.
• W4248066458 hasRelatedWork W3133057486 @default.
• W4248066458 isParatext "false" @default.
• W4248066458 isRetracted "false" @default.
• W4248066458 workType "article" @default.