Severe lactic acidosis secondary to minocycline in a teenager with infectious mononucleosis and mitochondrial myopathy

Mitochondrial myopathies are heterogeneous disorders with diverse presentations including laboratory findings of lactic acidosis. Often times they are diagnosed in childhood or the early teenage years following an infectious illness. Minocycline is a common antibiotic used for the treatment of acne. It has been reported to alter mitochondrial respiratory chain complexes. We report an interesting case of a teenager in which mitochondrial myopathy with severe lactic acidosis presented following a bout of infectious mononucleosis and minocycline use. It is hypothesized that oxidative stress from the infectious illness plus the minocycline use triggered the patientʹs presentation. The clinical manifestations and genetics of mitochondrial myopathies and treatment are discussed along with the management of lactic acidosis.