Case Report| Volume 57, ISSUE 4, P801-807, July 2018

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Green Bone: Minocycline-Induced Discoloration of Bone Rarely Reported in Foot and Ankle


      The tetracycline antibiotics incorporate into bone similar to bisphosphonates. Tetracycline stains bone a fluorescent yellow and minocycline, more commonly used for chronic acne, stains bone dark green. Owing to its frequent use, the occurrence of green bone discoloration due to antibiotics in the tetracycline class is well understood. Its pigmentation can be seen through delicate, thin tissue as a dark blue-gray. Histologic inspection of this bone will confirm a benign condition without evidence of bone disease. Although yellow and green discoloration has been documented frequently in association with oral surgery, it has been reported less commonly in the lower extremity. Green discoloration of bone has rarely been reported in the foot and ankle. Unlike other forms of hyperpigmentation of the skin and bone, this entity is benign when resulting from tetracycline therapy. It is always prudent to have a clinical correlate for an unusual discoloration or hyperpigmentation of any tissue when it exists. In the absence of a definitive clinical correlation, a biopsy is warranted. The following case studies provide a pictoral of green bone as it was encountered in the foot and ankle of 2 young adult females undergoing surgery.

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        • McCleskey P.E.
        • Littleton K.H.
        Minocycline-induced blue-green discoloration of bone, a case report.
        J Bone Joint Surg Am. 2004; 86A: 146-148
        • Wolfe I.D.
        • Reichmister J.
        Minocycline hyperpigmentation: skin, tooth, nail, and bone involvement.
        Cutis. 1984; 33: 457-458
        • Rumbak M.J.
        • Pitcock J.A.
        • Palmieri G.M.
        • Robertson J.T.
        Black bones following long-term minocycline treatment.
        Arch Pathol Lab Med. 1991; 115: 939-941
        • Pandit S.
        • Hadden W.
        Black pigmentation of bone due to long-term minocycline use.
        Surgeon. 2004; 2: 236-237
        • Oklund S.A.
        • Prolo D.J.
        • Gutierrez R.V.
        The significance of yellow bone.
        JAMA. 1981; 246: 761-763
        • Eisen D.
        • Hakim M.D.
        Minocycline-induced pigmentation, incidence, prevalence and management.
        Drug Saf. 1998; 18: 431-440
        • Boulos P.R.
        • Knoepp S.M.
        • Rubin P.A.D.
        Green bone.
        Arch Ophthalmol. 2007; 125: 380-386
        • Demers P.
        • Fraser D.
        • Goldbloom R.B.
        • Haworth J.C.
        • LaRochelle J.
        • MacLean R.
        • Murray T.K.
        Effects of tetracyclines on skeletal growth and dentition. a report by the nutrition committee of the Canadian Paediatric Society.
        Can Med Assoc J. 1968; 99: 849-854
        • van Der Bijl P.
        • Pitigoi-Aaron G.
        Tetracyclines and calcified tissues.
        Ann Dent. 1995; 54: 69-72
        • Saivin S.
        • Houin G.
        Clinical pharmacokinetics of doxycycline and minocycline.
        Clin Pharmacokinet. 1988; 15: 355-366
        • Golub L.M.
        • Ramamurthy N.S.
        • McNamara T.F.
        • Gomes B.
        • Wolff M.
        • Casino A.
        • Kapoor A.
        • Zambon J.
        • Ciancio S.
        • Schneir M.
        • Perry H.
        Tetracyclines inhibit tissue collagenase activity. A new mechanism in the treatment of periodontal disease.
        J Periodontal Res. 1984; 19: 651-655
        • Ozog D.M.
        • Gogstetter D.S.
        • Scott G.
        • Gaspari A.A.
        Minocycline-induced hyperpigmentation in patients with pemphigus and pemphigoid.
        Arch Dermatol. 2000; 136: 1133-1138
        • Kolback D.N.
        • Remme J.J.
        • Bos W.H.
        • Jonkman M.F.
        • De Jong M.C.J.M.
        • Pas H.H.
        • van Der Meer J.B.
        Bullous pemphigoid successfully controlled by tetracycline and nicotinamide.
        Br J Dermatol. 2006; 133: 88-90
        • Williams S.
        • Wakisaka A.
        • Zeng Q.Q.
        • Barnes J.
        • Seyedin S.
        • Martin G.
        • Wechter W.J.
        • Liang C.T.
        Effect of minocycline on osteoporosis.
        Adv Dent Res. 1998; 12: 71-75
        • Fenske N.A.
        • Millns J.L.
        Cutaneous pigmentation due to minocycline hydrochloride.
        J Am Acad Dermatol. 1980; 3: 308-310
        • Klapisz-Wolikow M.
        • Saffar J.L.
        Minocycline impairment of both osteoid tissue removal and osteoclastic resorption in a synchronized model of remodeling in the rat.
        J Cell Physiol. 1996; 167: 359-368
        • Westbury L.W.
        • Najera A.
        Minocycline-induced intraoral pharmacogenic pigmentation: case reports and review of the literature.
        J Periodontol. 1997; 68: 84-91
        • Ridgway H.A.
        • Sonnex T.S.
        • Kennedy C.T.
        • Millard P.R.
        • Henderson W.J.
        • Gold S.C.
        Hyperpigmentation associated with oral minocycline.
        Br J Dermatol. 1982; 107: 95-102
        • Basler R.S.
        Minocycline-related Hyperpigmentation.
        Arch Dermatol. 1985; 121: 606-608
        • Cale A.E.
        • Freedman P.D.
        • Lumerman H.
        Pigmentation of the jawbones and teeth secondary to minocycline hydrochloride therapy.
        J Periodontol. 1988; 59: 112-114
        • Milch R.A.
        • Rall D.P.
        • Tobie J.E.
        Bone localization of the tetracyclines.
        J Natl Cancer Inst. 1957; 19: 87-93
        • Hilton H.B.
        Skeletal pigmentation due to tetracycline.
        J Clin Pathol. 1962; 15: 112-115
        • Dahners L.E.
        • Bos G.D.
        Fluorescent tetracycline labeling as an aid to debridement of necrotic bone in the treatment of chronic osteomyelitis.
        J Orthop Trauma. 2002; 16: 345-346
        • Cohlan S.Q.
        • Bevelander G.
        • Tiamsic T.
        Growth inhibition of prematures receiving tetracycline: a clinical and laboratory investigation of tetracycline-induced bone fluorescence.
        Am J Dis Child. 1963; 105: 453-461
        • Bevelander G.
        • Nakahara H.
        • Rolle G.K.
        The effect of tetracycline on the development of the skeletal system of the chick embryo.
        Dev Biol. 1960; 2: 298-312
        • Simmons D.J.
        • Chang S.L.
        • Russell J.E.
        • Grazman B.
        • Webster D.
        • Oloff C.
        The effect of protracted tetracycline treatment on bone growth and maturation.
        Clin Orthop Relat Res. 1983; 180: 253-259
        • Benitz K.F.
        • Roberts G.K.
        • Yusa A.
        Morphologic effects of minocycline in laboratory animals.
        Toxicol Appl Pharmacol. 1967; 11: 150-170
        • Milch R.A.
        • Rall D.P.
        • Tobie J.E.
        Fluorescence of tetracycline antibiotics in bone.
        J Bone Joint Surg Am. 1958; 40: 897-910
        • Frost H.M.
        • Villanueva A.R.
        • Roth H.
        • Stanisavljeciv S.
        Tetracycline bone labeling.
        J New Drugs. 1961; 1: 206-216
        • Frost H.M.
        • Villanueva A.R.
        Tetracycline staining of newly forming bone and mineralizing cartilage in vivo.
        Stain Technol. 1960; 35: 135-138
        • Bassett E.J.
        • Keith M.S.
        • Armelagos G.J.
        • Martin D.L.
        • Villanueva A.R.
        Tetracycline-labeled human bone from ancient Sudanese Nubia (A.D. 350).
        Science. 1980; 209: 1532-1534
        • Meyer A.J.
        • Nahass G.T.
        Hyperpigmented patches on the dorsa of the feet.
        Arch Dermatol. 1995; 131: 1447-1448