Polymorphic Exanthem Induced By Amoxycillin In A Child Case With Infectious Mononucleosis

Case Series

Austin J Dermatolog. 2015;2(1): 1033.

Polymorphic Exanthem Induced By Amoxycillin In A Child Case With Infectious Mononucleosis

Göknur Bilen1*, Müzeyyen Gönül1, Mehmet Koçak1, Aysun Gökce2, Hilal Ayvaz1 and Filiz Canpolat1

1Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Dermatology, Ankara, Turkey

2Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Pathology, Ankara, Turkey

*Corresponding author: Göknur Bilen, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Dermatology, Pınarbaşı Mah. Batman Sk. No:5/6 Keçiören, Ankara, Turkey

Received: December 27, 2014; Accepted: February 24, 2015; Published: February 26, 2015


Seven year old girl presented with sore throat, fever, fatigue; amoxicillin clavulanic acid therapy had been started in a clinic. In 7th day of treatment widespread rash all over her body began. On dermatological examination all over the body was covered by target-like, petechial lesions and in some areas maculopapular lesions with becoming faded by pressure. In laboratory examinations 3-5 times increased liver enzymes, complete blood count with lymphocytosis were found. In serological tests EBV Viral Capsid Antigen (VCA) IgG and IgM were positive. EBV IgM/EBV IgG ratio was found 3 times higher. Based on clinical, histopathological and laboratory examinations it was thought as Epstein Barr Virus (EBV) rash induced by amoxicillin.

Infectious mononucleosis caused by EBV infection, usually affects children and adolescents. Aminopenicillins used during this infection may cause maculopapular rash. Development of polimorfic lesions is relatively rare. Although rashes seen while the treatment with aminopenicillin, drug eruptions must be thought firstly;infectious mononucleosis must take place in differential diagnosis.


Ebstein Barr Virus (EBV) is a gamma herpes virus which can cause Infectious Mononucleosis (IM), nasopharyngeal carcinoma, Burkitt lymphoma, Hodgkin lymphoma, lymphoproliferative disease after transplantation and oral hairy leukoplakia in HIV positive patients [1,2]. Primary EBV infections are generally subclinic. The diagnosis is made by serological tests [3]. IM caused by EBV commonly has fever, sore throat and lymphadenopathy [2]. Rarely, there could be complications such as hepatomegaly, splenomegaly, icterus and splenic rupture [4]. While using especially aminopenicillin group antibiotics, maculopapular or urticarial rashes generally occur. In this case report, a 7 year-old child with polymorphic rashes after using amoxycillin treatment in acute IM has been presented.


7 year-old girl was admitted to our clinic with disseminated rashes on her whole body after 7 day long amoxicillin treatment for sore throat, fever and fatigue complaints. From her personal history, it is learned that she could use amoxicillin therapy without having any reaction. The patient neither has another disease nor uses any medication.

In physical examination, hyperemic, hypertrophic and cryptic tonsils were found. There was tenderness on the right upper quadrant of the abdomen. Lymphadenopathy and hepatosplenomegaly were not detected. In dermatological examination, disseminated maculopapular rashes, target-like and petechial lesions were seen especially on upper extremities and torso (Figure 1,2).