Antibiotic Induced Cutaneous Rash in Infectious Mononucleosis: Overview of the Literature

Antibiotic-Induced Rash in Patients With Infectious Mononucleosis

“…The most commonly proposed mechanism of ASR in the setting of IM is that the underlying viral infection triggers antibiotic hypersensitivity secondary to immune system alterations, as opposed to the development of a true, persistent drug allergy. 38,39 A consistent finding in IM is significant lymphocytosis with a marked expansion of activated CD8+ T-lymphocytes. The severity of the clinical presentation of IM (eg, fever, pharyngitis, and lymphadenopathy) appears to correlate with the extent of the activated CD8+ T-cell fraction.…”

“…Another factor requiring further clarification is the role of age in the pathogenesis of hypersensitivity responses to antibiotics in IM. Ónodi-Nagy et al 39 have suggested that because EBV infection in the very young (before age 4) is often asymptomatic or presents in a nonspecific manner, true persistent delayed-type hypersensitivity reactions may be less likely to be observed in infants and children than in young adults with IM.…”

“…41,42 It is believed that an important contributing factor to the predisposition to ASR in the setting of IM is the suppression of interleukin-10 activity. 39 It appears that sufficient interleukin-10 activity is required to maintain immune tolerance and to limit immune responsiveness to certain antigens. In addition, suppression of interleukin-10 allows for an increase in activated Th1 cells (type 1 helper T-lymphocytes), which are known to contribute to the development of delayed-type hypersensitivity reactions.…”

“…Therefore, a deficiency of interleukin-10 activity can lead to the emergence of hypersensitivity to antigens. 39 As a result, the introduction of antibiotic molecules in the setting of EBV-mediated immune alterations sets the stage for a hypersensitivity reaction and the presentation of an erythematous, maculopapular cutaneous eruption in patients who otherwise would tolerate the presence of these antigens 39,41,42 (Figure 1). The conclusion that EBVassociated ASR is not principally caused by true drug allergy but is primarily a product of transient and reversible virusmediated immune alterations is further supported by reports, although few in number, of failure to provoke recurrence of rash after antibiotic rechallenge.…”

Morbilliformes Exanthem im Kindesalter: Hinweis auf eine Antibiotika-Allergie

“…Obwohl die genauen pathogenetischen Mechanismen nicht bekannt sind, geht man davon aus, dass die Viren die Toleranz des Immunsystems gegenüber dem Antibiotikum reduzieren. In der Literatur werden Inzidenzraten für das Exanthem bei Patienten mit infektiöser Mononukleose von 80-100% mit und 9-23% ohne Antibiotikagabe angegeben [1]. …”