title: Rash associated with piperacillin/tazobactam administration in infectious mononucleosis.
abstract: OBJECTIVE
  To report a case of piperacillin/tazobactam-induced rash in a patient with infectious mononucleosis.
  
  
  METHODS
  A 25-year-old white man developed a rash while receiving piperacillin/tazobactam 3.375 g intravenously every 6 hours and gentamicin for osteomyelitis complicating a left femur fracture secondary to a motorcycle accident. Due to progression of the rash following additional doses of piperacillin/tazobactam during hospitalization, the patient's antimicrobial regimen was changed to vancomycin and meropenem. Subsequently, a mononucleosis spot test was positive, and both Epstein-Barr virus (EBV) immunoglobulin (Ig) G and IgM antibodies were positive. The rash rapidly resolved with the discontinuation of piperacillin/tazobactam.
  
  
  CONCLUSIONS
  Although the development of rash following the administration of several different antimicrobials, especially ampicillin, has been previously reported, this is the first report of piperacillin/tazobactam-induced rash in infectious mononucleosis. The rash is generally self-limiting and usually resolves within days of discontinuing the causative antimicrobial agent. An altered drug metabolism or an immune-mediated process has been suggested as the potential mechanism for rash development.
  
  
  CONCLUSIONS
  Prior reports of antimicrobial-induced rash in infectious mononucleosis and a positive laboratory diagnosis of EBV in our patient with no history of penicillin allergy support the identification of piperacillin/tazobactam as the inducer of the rash. According to the Naranjo probability scale, the association of piperacillin/tazobactam with the rash was classified as probable.
authors.affiliation: Pharmacy Services, Chandler Medical Center, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0293, USA.
authors.forename: Aimée C
authors.initials: AC
authors.lastname: LeClaire
authors.forename: Craig A
authors.initials: CA
authors.lastname: Martin
authors.forename: Ardis D
authors.initials: AD
authors.lastname: Hoven
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004338:Drug Combinations; D003875:Drug Eruptions / Q000209:etiology*; D006801:Humans; D007244:Infectious Mononucleosis / Q000188:drug therapy*; D008297:Male; D010397:Penicillanic Acid / Q000009:adverse effects* / Q000031:analogs & derivatives; D010878:Piperacillin / Q000009:adverse effects*; D000077725:Piperacillin, Tazobactam Drug Combination
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin