Gujar Amrita A, Pernudi Kimberly, Adeyinka Adebayo, Kondamudi Noah
Pediatrics, The Brooklyn Hospital Center, Brooklyn, USA.
Pediatric Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, USA.
Cureus. 2025 Jul 11;17(7):e87737. doi: 10.7759/cureus.87737. eCollection 2025 Jul.
A 19-year-old transgender adolescent on hormonal therapy with a history of recent hospitalization for exudative tonsillitis presented with worsening sore throat, dysphagia, fever, and a diffuse, generalized macular rash involving the back, face, abdomen, arms, and legs. Despite prior antibiotic treatment with amoxicillin, her symptoms recurred, prompting further evaluation. Laboratory findings revealed leukocytosis with lymphocytic and monocytic predominance, elevated inflammatory markers, and a positive Epstein-Barr virus (EBV) test, confirming infectious mononucleosis. Imaging demonstrated persistent tonsillitis without abscess formation, and additional testing identified concurrent herpes simplex virus (HSV)-1 oral ulcers. Given persistent fevers and systemic inflammation, hemophagocytic lymphohistiocytosis (HLH) was considered but not confirmed. Management included IV clindamycin for tonsillitis, corticosteroids for airway inflammation, and doxycycline for atypical pneumonia. Over the 10-day hospitalization, the patient showed gradual improvement, with resolution of the rash and all other symptoms. The rash was ultimately diagnosed as an amoxicillin-induced rash associated with EBV infection. This case highlights the importance of recognizing amoxicillin-induced rash in EBV infection and distinguishing it from allergic reactions and other common rashes, including but not limited to scarlet fever, viral exanthem, drug reactions, and HLH. Although various skin rashes are common in the transgender population, a literature review found no evidence linking amoxicillin-induced EBV rash to transgender patients. Accurate diagnosis aids in the appropriate selection of antimicrobial therapy and helps avoid unnecessary antibiotic restrictions due to misattributed allergic reactions.
一名19岁接受激素治疗的 transgender 青少年，近期因渗出性扁桃体炎住院，现出现咽痛加重、吞咽困难、发热，以及背部、面部、腹部、手臂和腿部弥漫性全身性斑疹。尽管之前使用阿莫西林进行了抗生素治疗，但其症状仍复发，促使进一步评估。实验室检查发现白细胞增多，以淋巴细胞和单核细胞为主，炎症标志物升高，EB病毒（EBV）检测呈阳性，确诊为传染性单核细胞增多症。影像学检查显示持续性扁桃体炎，无脓肿形成，进一步检查发现并发单纯疱疹病毒（HSV）-1口腔溃疡。鉴于持续发热和全身炎症，考虑了噬血细胞性淋巴组织细胞增生症（HLH），但未确诊。治疗包括静脉注射克林霉素治疗扁桃体炎、使用皮质类固醇治疗气道炎症、使用强力霉素治疗非典型肺炎。在为期10天的住院期间，患者逐渐好转，皮疹及所有其他症状均消失。皮疹最终被诊断为与EBV感染相关的阿莫西林诱发皮疹。该病例强调了在EBV感染中识别阿莫西林诱发皮疹并将其与过敏反应及其他常见皮疹（包括但不限于猩红热、病毒疹、药物反应和HLH）相区分的重要性。尽管各种皮疹在transgender人群中很常见，但文献综述未发现证据表明阿莫西林诱发的EBV皮疹与transgender患者有关。准确的诊断有助于正确选择抗菌治疗，并有助于避免因错误归因的过敏反应而导致不必要的抗生素限制。
