Azithromycin, Epstein-Barr Virus, and cutaneous hypersensitivity: A rare adverse event? | ||||
| Microbes and Infectious Diseases | ||||
| Articles in Press, Accepted Manuscript, Available Online from 23 June 2025 | ||||
| Document Type: Short Reports (case reports) | ||||
| DOI: 10.21608/mid.2025.381058.2751 | ||||
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| Authors | ||||
Shienty Gaspersz   1; Paulus Mario Christopher 2; Nana Novia Jayadi 3
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| 1Department of Dermatology, Venereology, and Aesthetics Faculty of Medicine, Sam Ratulangi University/ R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia | ||||
| 2Department of Dermatology, Venereology, and Aesthetics, Faculty of Medicine, Sam Ratulangi University/ R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia | ||||
| 3Department of Dermatology, Venereology, and Aesthetics, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia | ||||
| Abstract | ||||
| Background: Epstein-Barr virus infection is often encountered in clinical practice, and is characterized by its triad of fever, tonsillar pharyngitis, and lymphadenopathy. A cutaneous reaction may develop during the disease course or as a result of medication. However, with the frequent use of antibiotics due to the similarity of IM and bacterial origin, the incidence of antibiotic-induced rash may rise. We present the case of a previously healthy 26-year-old Asian male with a four-day history of fever, generalized rash, arthralgia, and nausea, and who had been prescribed oral azithromycin. On admission, cervical lymphadenopathy, mild posterior pharyngeal wall erythema, and a generalized erythematous macular eruption were observed. Using the modified Naranjo Scale for antibiotic-induced rash associated with IM-specific criteria, the case was categorized as 'probable'. On follow-up, anti-EBV VCA IgM and IgG were positive, with a complete resolution of the skin rash two weeks after admission. Antibiotic-induced rash in a patient with IM is a unique phenomenon. The hypothesized mechanism of transient virus-mediated immune alterations leading to antigenic tolerance loss and the development of a reversible hypersensitivity reaction should be noted. A thorough history taking coupled with proper and cautious judgment for antibiotic prescription in the setting of suspected infection should be warranted. | ||||
| Keywords | ||||
| Antibiotic-induced rash; azithromycin; Epstein-Barr virus; hypersensitivity; infectious mononucleosis | ||||
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