Quinolone Drug Rash in a Patient with Infectious Mononucleosis

Abstract

Infectious mononucleosis and the associated ampicillin rash are well documented. The case of a patient with infectious mononucleosis who was treated with levofloxacin and developed a rash similar to the ampicillin rash is reviewed. The exact mechanism is not understood. With closer observation, physicians may be able to recognize more cases with similar phenomena.

Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitization

“…It is important to notice that the in vivo investigations were carried out at least six month after the disappearance of the eruptions which lead us to think that drug sensitization developed instead of a transient loss of tolerance, a transient Th-1 lymphocyte-mediated delayed type hypersensitivity reaction to the medication as discussed in the literature [17, 18]. …”

Antibiotic-Induced Rash in Patients With Infectious Mononucleosis

“…Reports of suspected ASR in patients with IM were systematically assessed for causality (Table 2). [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Statistical analysis of incidence rates utilized a 2 × 2 contingency table using χ 2 analysis. The independent variable was the administration of antibiotics to patients, and the dependent variable was the presence or absence of skin rash.…”

Antibiotic Induced Cutaneous Rash in Infectious Mononucleosis: Overview of the Literature

“…Down-regulation of type 4 interleukin (IL-4) decreases B lymphocytes' growth and development. Due to the depression of type 10 interleukin (IL-10) secretion its effect on Th1-lymphocyte suppression is absent [5,19]. Case reports, such as a case report by Leung et al support this concept, as some patients, similar to the one mentioned in this particular article, can take amoxicillin again after the previous rash without developing skin eruptions [2].…”

“…Later, other antibacterial drugs were also related to skin symptoms in IM, such as amoxicillin, talampicillin or methicillin [2,[16][17][18]. A few cases were reported about cephalexin, levofloxacin, erythromycin and azithromycin [5,[19][20][21][22]. More recent publications, not only case studies but clinical reports on larger patient groups, and reviews on previously published cases, discuss the connection between the viral infection and the antibiotic therapy.…”