title: Adverse antibiotic-induced eruptions associated with epstein barr virus infection and showing Kikuchi-Fujimoto disease-like histology.
abstract: The antibiotic-induced eruption of infectious mononucleosis is a well-known clinical phenomenon. Latent viral infection with herpesviridae (eg, human herpes virus 6 (HHV-6) and Epstein-Barr virus (EBV)) is suspected to play a role in the drug hypersensitivity syndrome. The cutaneous pathologic findings have not been reported in the former, and are infrequently reported in the latter entity. Herein, we describe the biopsy findings of a cefprozil-induced rash in infectious mononucleosis and a minocycline-associated drug hypersensitivity syndrome. Biopsy of these exanthematous eruptions revealed an acute vacuolar interface superficial and deep perivascular and interstitial lymphocytic dermatitis. CD8(+) lymphocytes predominated and were associated with non-neutrophilic nuclear (karyorrhectic) debris and numerous small CD68(+) and CD123(+) monocytes. These aforementioned features have been described in cutaneous lesions of Kikuchi-Fujimoto disease, an entity whose clinicopathologic findings overlap with both infectious mononucleosis and lupus erythematosus. Serologic evidence of active and chronic active EBV infection was found in both patients, respectively. No evidence of EBV or HHV6 was found in the cutaneous lesions. Plasmacytoid monocytes (CD68(+)/CD123(+) cells), which produce type I interferon, are believed to play a role in viral immunity by protecting other cells from viral infections and promoting survival of antigen-activated T cells. Their presence in these two putative examples of viral-drug immune dysregulation could be a clue to pathogenesis and represent a common cellular component of some adverse cutaneous drug eruptions.
authors.affiliation: Division of Dermatology, Department of Pathology, Albany Medical College, Albany, New York 12208, USA. carlsoa@mail.amc.edu
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Carlson
authors.forename: Amy
authors.initials: A
authors.lastname: Perlmutter
authors.forename: Ellis
authors.initials: E
authors.lastname: Tobin
authors.forename: Derek
authors.initials: D
authors.lastname: Richardson
authors.forename: Angela
authors.initials: A
authors.lastname: Rohwedder
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D020042:Histiocytic Necrotizing Lymphadenitis / Q000150:complications* / Q000473:pathology / Q000821:virology; D006801:Humans; D017403:In Situ Hybridization; D007244:Infectious Mononucleosis / Q000150:complications* / Q000473:pathology / Q000821:virology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008911:Minocycline / Q000009:adverse effects*; D012367:RNA, Viral / Q000032:analysis; D012867:Skin / Q000187:drug effects / Q000473:pathology; D000097670:Cefprozil
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D008911:Minocycline; D012367:RNA, Viral; D000097670:Cefprozil; C099537:Epstein-Barr virus encoded RNA 1