Watanabe Hirofumi, Sainokami Shigehiro, Adachi Natsuho, Takizawa Keiichi, Kanda Shoichiro
Pediatrics, The University of Tokyo, Tokyo, JPN.
Cureus. 2025 Jan 24;17(1):e77943. doi: 10.7759/cureus.77943. eCollection 2025 Jan.
Amoxicillin-associated rash is a well-documented phenomenon in Epstein-Barr virus (EBV)-related infectious mononucleosis. This case highlights a notable course where amoxicillin was administered during the latent phase of EBV infection, and the characteristic rash appeared following the clinical onset of infectious mononucleosis. A seven-year-old girl received amoxicillin for acute otitis media during EBV's latent phase. After developing fever, conjunctival injection, lip redness, cervical lymphadenopathy, and a generalized rash, she was initially diagnosed with Kawasaki disease and treated with intravenous immunoglobulin and aspirin. Serological testing later confirmed acute EBV infection, and the rash was attributed to prior amoxicillin use. This case illustrates that aminopenicillins, such as amoxicillin, can trigger characteristic rashes after the onset of infectious mononucleosis, even when administered during the infection's latent phase. It highlights the importance of detailed medication history-taking, particularly regarding drug use during the latent period, and the consideration of viral etiologies in febrile illnesses with rash, especially when symptoms overlap with systemic inflammatory conditions.
阿莫西林相关皮疹是爱泼斯坦-巴尔病毒（EBV）相关传染性单核细胞增多症中一种有充分文献记载的现象。本病例突出了一个值得注意的病程，即在EBV感染的潜伏期给予阿莫西林，而特征性皮疹在传染性单核细胞增多症临床发病后出现。一名七岁女孩在EBV潜伏期因急性中耳炎接受了阿莫西林治疗。在出现发热、结膜充血、嘴唇发红、颈部淋巴结肿大和全身性皮疹后，她最初被诊断为川崎病，并接受了静脉注射免疫球蛋白和阿司匹林治疗。血清学检测后来证实为急性EBV感染，皮疹归因于之前使用过阿莫西林。本病例表明，即使在感染潜伏期使用，阿莫西林等氨基青霉素也可在传染性单核细胞增多症发病后引发特征性皮疹。它突出了详细询问用药史的重要性，特别是关于潜伏期用药情况，以及在伴有皮疹的发热性疾病中考虑病毒病因的重要性，尤其是当症状与全身性炎症性疾病重叠时。
