Eosinophilia in Amoxicillin-Induced Rash in Infectious Mononucleosis

Abstract

A link between amoxicillin-induced rash in infectious mononucleosis and allergy has been previously reported. However, the pathophysiological cause and aspects are unclear. Additionally, the complex immunological interaction between the host and Epstein-Barr virus needs to be studied. This article reports a case of amoxicillin-induced rash in infectious mononucleosis resulting in an exuberant rash, facial edema, and marked eosinophilia, which prompted additional workup. Both the eosinophilia and the rash brought to light a possible association with a persistent delayed-type hypersensitivity. Further scientific discussion and investigation can identify predictive indicators that can portend clinical outcome.

Infectious mononucleosis: new concepts in clinical presentation, epidemiology, and host response

“…Recent findings show that EBV IM has been consistently associated with MS this contrasts with CMV IM which shows an inverse association [17 One of the key challenges for treating practitioners, is the prompt distinction of bacterial tonsillitis from IM, which presents with pharyngitis. Inappropriate antibiotic treatment for a bacterial tonsillitis in IM cases can result in a high percentage of patients developing an ampicillin rash owing to a transient penicillin hypersensitivity occurring during the early acute stage of the viral infection [20][21][22].…”

“…These skin eruptions can present as maculopapular exanthemas, morbilliform eruptions on the whole body and in severe cases this progressive skin reaction can turn into an erythroderma [24]. The viral skin rash that develops without antibiotic intervention is less common (5-15% of patients) [23]; the majority of rashes that occur being a consequence of the inappropriate treatment with antibiotics [21,25].…”

Influence of Epstein-Barr virus infection on developing multiple sclerosis

“…Z racji podobieństwa obrazu klinicznego, zdarza się, iż mononukleoza zakaźna jest błędnie diagnozowana jako angina paciorkowcowa i leczona antybiotykami. Podanie antybiotyków wiążę się z wystąpieniem na ciele wysypki odropodobnej [48,49]. Wówczas ostateczną diagnozę IM potwierdzają testy na obecność przeciwciał heterofilnych klasy IgM [51] oraz badanie PCR wykazujące obecność wirusa we krwi.…”