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[Ampicillin and infectious mononucleosis. Skin manifestations]

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.

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