Contribution of HLA-DRB1 * 09: 01 allele to development of minocycline induced antineutrophil cytoplasmic antibody (ANCA)-associated cutaneous vasculitis: report of two cases

Mod Rheumatol Case Rep. 2020 Jul;4(2):267-271. doi: 10.1080/24725625.2020.1738983. Epub 2020 Mar 19.


We report two cases of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) that developed after long-term oral administration of minocycline and consider the contribution of human leukocyte antigen (HLA)-DRB 1 * 09: 01 allele to its development. Case 1; A 47-year-old man receiving minocycline for palmoplantar pustulosis for 24 months developed fever, arthralgia, and irregular livedo on the bilateral lower legs. Skin biopsy demonstrated vasculitis, while a blood test showed positivity of myeloperoxidase (MPO)-ANCA. Discontinuation of minocycline and oral administration of prednisolone relieved the symptoms promptly. Case 2; A 53-year-old woman developed reddish-brown livedo reticularis with tenderness on the bilateral lower legs after administration of minocycline to treat palmoplantar pustulosis for 24 months. Although skin biopsy did not demonstrate vasculitis, a blood test showed MPO-ANCA positivity. Cessation of minocycline resulted in rapid improvement of the cutaneous lesions and constitutional symptoms. We diagnosed both cases as having Drug-associated ANCA-associated Vasculitis (DAV) caused by minocycline according to the diagnostic criteria proposed by Cluver et al. Further examination revealed the presence of HLA-DRB1 * 09:01 allele in both cases. This allele has been implicated in the genetic background of idiopathic microscopic polyangiitis (MPA) in the Japanese population. Our finding suggests a relationship between the development of MPO-ANCA or DAV caused by minocycline and HLA-DRB1 * 09:01 allele, but will have to confirmed by further studies with larger numbers of patients.

Keywords: HLA-DRB1 * 09: 01; antineutrophil cytoplasmic antibodies (ANCA); cutaneous vasculitis; drug-associated vasculitis; minocycline.

Publication types

  • Case Reports

MeSH terms

  • Alleles*
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / diagnosis*
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / etiology*
  • Biomarkers
  • Biopsy
  • Disease Susceptibility
  • Female
  • Genetic Predisposition to Disease
  • HLA-DRB1 Chains / blood
  • HLA-DRB1 Chains / genetics*
  • HLA-DRB1 Chains / immunology*
  • Humans
  • Male
  • Middle Aged
  • Minocycline / adverse effects*


  • Biomarkers
  • HLA-DRB1 Chains
  • Minocycline