Minocycline and Pseudotumor cerebri: The well-known but well-kept secret.

To the Editor. Minocycline, a synthetic derivative of tetracycline, is the most widely prescribed oral systemic antibiotic for acne vulgaris because it does not appear to induce resistance in Propionobacterium acnes and can be administered only once or twice a day. Interestingly, minocycline is lipophilic and penetrates the blood-brain barrier more readily than other tetracyclines, thus attaining higher cerebrospinal fluid (CSF) levels. Despite its widespread use among adolescents, it does not appear that adequate prospective studies have been published to investigate its specific effects on the maturing teenager. Recent personal experience allowed for more careful study of the effects of minocycline. Specifically, our then 12 9 12 -year-old son initiated minocycline (100 mg twice a day) by mouth for the treatment of moderately severe acne. Four weeks later, he was examined by a senior pediatric ophthalmologist for his annual assessment of myopia. An entirely normal examination (including pupil dilation and fundoscopic assessment) was documented, but 4 weeks later he complained of a global headache that was modestly relieved by an oral analgesic (day 1). The next day (day 2) he developed vomiting and diarrhea with a low-grade temperature. By day 3, the vomiting and diarrhea had improved, he had defervesced, but he began to complain of visual glare. Although he noticed slight double vision, he did not mention it until late …