# Amoxicillin-Induced Hypersensitivity Versus Viral Exanthem in Epstein-Barr Virus Infection: A Paediatric Case Series

## TL;DR

This case series highlights the challenge of distinguishing amoxicillin hypersensitivity from viral rashes in adolescents with Epstein-Barr virus infections.

## Contribution

The study provides clinical evidence of true amoxicillin hypersensitivity in EBV-infected adolescents through drug provocation testing.

## Key findings

- Three adolescents with EBV infection developed generalized rashes after amoxicillin treatment.
- Drug provocation testing confirmed true delayed hypersensitivity to amoxicillin in all three cases.
- The findings emphasize the need for thorough allergy evaluation to prevent future hypersensitivity reactions.

## Abstract

Epstein-Barr virus (EBV) infection is often associated with skin rashes following aminopenicillin treatment, such as amoxicillin, typically considered a benign and transient reaction. However, distinguishing between non-allergic exanthems and true hypersensitivity remains a clinical challenge, especially in children and adolescents.

This case series reports three cases of adolescents who developed generalized exanthematous eruptions following the administration of amoxicillin during acute EBV infection, confirmed by serological testing. All patients underwent standardized allergy evaluation through drug provocation testing at least ten weeks after rash resolution, which confirmed true delayed hypersensitivity to amoxicillin.

These three pediatric cases reinforce the need for heightened clinical vigilance when a skin rash occurs during EBV infection treated with amoxicillin. While such rashes are often attributed to transient viral-drug interactions, our findings highlight the importance of considering the possibility of true amoxicillin hypersensitivity. Careful evaluation, including comprehensive allergy work-up when appropriate, is essential to accurately identify a true aminopenicillin allergy and thereby reduce the risk of future severe hypersensitivity reactions.