Before continuing, please go back and read the case from Diagnostic Dilemma: The Great Mimicker

The answer is to stop Minocycline and start hydrochloroquine.

This is a case of minocycline-induced lupus, which explains the patient’s symptoms, her low compliment, and the positive p-ANCA test. None of the other answer choices adequately address this condition or explain what is going on with the patient. The joint aspiration findings do not support a diagnosis of prosthetic joint infection based on most recent guidelines, therefore adding antibiotics are not the correct answer in this case.  Treatment for minocycline-induced lupus is to first and foremost stop the offending drug, and then provide either steroids or hydroxychloroquine therapy. A good overview of this syndrome is offered here. Although not common, physicians should be aware that minocycline has the ability to cause a wide variety of syndromes, ranging from lupus to serum sickness and vasculitis, and if present, knowing what to do may save the patient unnecessary testing and grief.

Dr. Babiker, one of the First year ID-fellows, presented a similar case and Pitt ID Grand Rounds.  While drug induced lupus has a relatively equal gender distribution (unlike SLE), minocycline -related disease is more common in young females, often due to long-term use of this agent for acne.