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Tetracycline and its related compounds are known to cause hyperpigmentation and discoloration of the skin, bone, and palatine fossa.1 Minocycline can cause a characteristic gray or brown discoloration of the skin, which may resolve slowly after the medication is discontinued. ' It is a rare occasion that direct visualization of bone occurs in a patient taking chronic minocycline, and when it happens, the often striking brown, black, or gray discoloration often is considered by the surgeon to be diseased bone.2
This article presents a case of hyperpigmented bone as a consequence of chronic minocycline usage as suppressive therapy for methicill in-resistant Staphyhcoccus aureus (MRSA).
CASE REPORT
A 37-year-old woman presented for removal of an infected plate adjacent to a femoral fracture. She had suffered a subtrochanteric left femoral fracture from a motor vehicle accident four years previously, with plate insertion. Eventually, the patient had nonunion of her fracture and developed osteomyelitis with MRSA.
Treatment consisted of 6 weeks of intravenous therapy with vancomycin, followed by suppression with minocycline, 100 mg twice a day. Approximately fwo years later, surgery for removal of the infected plate revealed a diffusely dark gray-brown appearance of firm bone (figure). The initial impression was necrotic bone.
The arrow in the figure indicates a region of bone with a patchy brown to gray-black hyperpigmentation, which is typical of the effects of this antibiotic. Bone cultures for routine bacterial and fungal isolation were negative.
The patient had no cutaneous, dental, or palatine hyperpigmentation. Based on the characteristic appearance of the bone and lack of evidence of an invasive infectious disease, she was diagnosed...