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Tonsillitis I: Introduction

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Updated: Sep 11, 2025

Separation of Immune Cell Subpopulations in Peripheral Blood Samples from Children with Infectious Mononucleosis

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Published on: September 7, 2022

Epstein-Barr Virus (EBV) Masquerading as Exudative Tonsillitis and Rash in a Transgender Adolescent.

Amrita A Gujar¹, Kimberly Pernudi¹, Adebayo Adeyinka¹

¹Pediatrics, The Brooklyn Hospital Center, Brooklyn, USA.

|August 11, 2025

Summary

A 19-year-old transgender adolescent developed a rash after amoxicillin treatment for tonsillitis, later diagnosed as an Epstein-Barr virus (EBV)-associated amoxicillin-induced rash. This case underscores the importance of accurate diagnosis to avoid unnecessary antibiotic restrictions.

Keywords:

allergy and anaphylaxis amoxicillin-associated rash atypical rash ebv positive transgender medicine

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Area of Science:

Infectious Diseases
Dermatology
Adolescent Medicine

Background:

A 19-year-old transgender adolescent on hormonal therapy presented with recurrent tonsillitis and a generalized rash.
Initial treatment with amoxicillin for tonsillitis was followed by symptom recurrence and rash development.

Observation:

Laboratory tests confirmed Epstein-Barr virus (EBV) infection, indicative of infectious mononucleosis.
Concurrent herpes simplex virus (HSV)-1 oral ulcers were noted.
Hemophagocytic lymphohistiocytosis (HLH) was considered but ruled out due to persistent systemic inflammation.

Findings:

The patient's rash was diagnosed as an amoxicillin-induced rash secondary to EBV infection.
Management included IV clindamycin, corticosteroids, and doxycycline.
The patient recovered fully within a 10-day hospitalization.

Implications:

Accurate differentiation of amoxicillin-induced rash in EBV infection is crucial for appropriate antimicrobial selection.
Misattribution of the rash can lead to unnecessary antibiotic restrictions and avoidance of effective treatments.
This case highlights a rare presentation in an adolescent on hormonal therapy, with no prior literature linking this specific rash to transgender patients.