Infectious mononucleosis skin rash without previous antibiotic use

A 20-year-old female patient presented with fever, pharyngitis and lymphadenopathy. The diagnosis of infectious mononucleosis was established by high levels of IgM antibodies against the Epstein-Barr virus. Fifteen days after the onset of symptoms she developed a maculopapular generalized rash (Fig. 1), which resolved within a few days, without any special treatment. She had not received antibiotics or any other drug.

Fig. 1 -.
Maculopapular generalized rash on patient's back.

Patients with infectious mononucleosis may present with a non pruritic, faint rash during the course of the disease, which is believed to be caused directly by the virus. This is in contrast with the rash observed in patients who received beta-lactam antibiotics, mainly ampicillin or amoxicillin, which is associated with a hypersensitivity reaction to the antibiotic¹ and it is usually pruritic and prolonged. Other, less common, skin manifestations of infectious mononucleosis include, among others, erythema nodosum, erythema multiforme, and urticaria.² Our patient completely recovered within 3 months, with no complications.

References

• ¹
  Banerjee I, Mondal S, Sen S, Tripathi SK, Banerjee G. Azithromycin-induced rash in a patient of infectious mononucleosis - a case report with review of literature. J Clin Diagn Res. 2014;8:HD01-2.
• ²
  Di Lernia V, Mansouri Y. Epstein-Barr virus and skin manifestations in childhood. Int J Dermatol. 2013;52:1177-84.

Publication Dates

• Publication in this collection
  Sep-Oct 2015

History

• Received
  13 Apr 2015
• Accepted
  22 Apr 2015