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[Ampicillin and infectious mononucleosis. Skin manifestations]
Abstract:
Cutaneous reaction by ampicillin, do present themselves with a greater frequency than other penicillin derivates and in general rule they are of the urticaria or exanthematous type. The administration to patients with infective mononucleosis or when it is applied together with allopurinol, the risk of cutaneous reactions is greater. There appears a twenty year old, female patient, who by reason of a febrile reaction with odinofagia, is medicated with ampicillin of 1500 milligrams daily, and this unchains generalized morbilliform exantheme, lightly desquamative-a-sole of the feet, hear skin, and being very showy the edema on face. Besides she presented a diffuse enantema. The clinic examination revealed macropolyadenopathy, hepatomegaly, splenomealy and mesosystolic blast. The laboratory showed 55% lymphocytosis, Turk cells and Downey cells. Erythrocyte sedimenation rate 16-36 mm/hs. Total hemolytic complement 105 U (V. N. 160-260). Hipergammaglobulinemia 2,11 mg/dl. Hypergammaglobulinemia total 2 mg/dl. Fosgefose selceline 204 mU/ml. TGO 120 mU/ml. Cholesterol 115 mg/dl. Hyperuricemic 115 mg/dl. Serology for Epstein-Barr virus: 1:40. The rest of proofs did not reveal data of importance. In the infective mononucleosis are described varied cutaneous manifestations which are fugacious and not very frequent. On the contrary the clinic aspect as the observed one in this case, has more intensive and generalized characteristics. It is considered a toxic phenomena because of the proved absence of sensibility to penicillin derivates. Authors advert on the administration of this drug in indefinite pharyngeal cases.
Insights
Ampicillin can cause severe skin reactions, especially in patients with infectious mononucleosis. This case highlights a severe reaction, suggesting a toxic effect rather than an allergy.
Area of Science:
- Dermatology
- Infectious Diseases
- Pharmacology
Background:
- Ampicillin, a penicillin derivative, frequently causes cutaneous reactions, typically urticarial or exanthematous.
- The risk of ampicillin-induced skin reactions increases in patients with infectious mononucleosis or when co-administered with allopurinol.
Observation:
- A 20-year-old female with infectious mononucleosis developed a generalized, desquamative morbilliform exanthem, facial edema, and enanthem after receiving ampicillin.
- Clinical examination revealed macropolyadenopathy, hepatomegaly, splenomegaly, and a mesosystolic murmur.
- Laboratory findings included lymphocytosis with atypical cells (Turk and Downey cells), elevated erythrocyte sedimentation rate, and hypergammaglobulinemia.
Findings:
- The patient presented with severe, generalized cutaneous manifestations, atypical for typical ampicillin reactions.
- Laboratory results, including Epstein-Barr virus serology, confirmed infectious mononucleosis.
- The reaction was deemed a toxic phenomenon due to the absence of penicillin sensitivity.
Implications:
- This case underscores the potential for severe, toxic cutaneous reactions to ampicillin, particularly in the context of infectious mononucleosis.
- Physicians should exercise caution when prescribing ampicillin for pharyngeal infections of unclear etiology due to the heightened risk of adverse reactions.