Morbilliform exanthema

Exanthemas are observed as prodromal skin symptoms in acute viral hepatitis (5-20% of cases). They can be manifested as urticaria, scarlatinoid or morbilliform exanthemas as well as varicella and erythematous multiform rashes. 

Exanthema 5-10 days Morbilliform exanthema, rash Sensitized lymphocytes or IgG immune complexes IgG and IgM BPO and minor determinants... 

Morbilliform exanthema, fixed drug eruptions, and erythrodermia are thought to result from a cell-mediated reaction, i.e., T-lymphocytes as in contact sensitivity. However, the histologic pictures of both reactions differ in a number of features. Moreover, basophil infiltration, which is rather important in contact sensitivity, is often negligible in the tuberculin reaction. In spite of several differences between... 

Morbilliform exanthema differs markedly in morphological appearance and clinical evolution from the urticarial reaction described above. The skin lesions usually remain stable for a few days (instead of a few hours) and disappear promptly within a few days of interruption of penicillin treatment. It is not rare, however, to observe a mixture of both forms in the same patient. 

Morbilliform exanthema is tending to become the most frequent form of adverse reaction to penicillins (Table 3), but it is likely that this trend represents above all the increase of rashes following ampicillin treatment (for review see Al-MEYDA and Levantine 1972 Dewdney 1980 Bass et al. 1973 Beckmann 1971). 

Penicillamine is a chelating agent which binds copper, mercury, zinc, and lead. It has been used to treat poisoning from these chemicals and also for disorders of copper metabolism such as Wilson s disease and primary biliary cirrhosis. Penicillamine has been tried in scleroderma and arthritis. Hypersensitivity reactions are common. About 20%-30% of the patients show hypersensitivity reactions suchs as morbilliform exanthema, urticaria, purpura, anorexia, lymphadenopathy, leukopenia, and thrombocytopenia (Meyboom 1975 Balme and Huskisson 1977). More severe skin symptoms associated with penicillamine therapy are Stevens-Johnson syndrome, pemphigus, myasthenia gravis, cholestatic jaundice (Barzilai et al. 1978), nephropathy (Lange 1978) and lupus-like syndrome (Harpey et al. 1972). 

Honeycutt and Huldin (1963) pointed out that after isoniazid there occur morbilliform or maculopapular exanthemas, which only in rare cases proceed to dermatitis herpetiformis but are often combined with fever, swollen lymph nodes, eosinophilia, and icterus. In some cases there are hypersensitivity reactions which resemble systemic lupus erythematosus. In general, hypersensitivity reactions after isoniazid may present as fever, hepatitis, and morbilliform, maculopapular, pur-pura-like, and urticarial exanthemas (Fellner 1970). Hematologic reactions (agranulocytosis, eosinophilia, thrombocytopenia, and anemia) may also occur. 

Cases of allergic reactions to ascorbic acid are very rare. Early observations reported rubelliform, morbilliform, and scarlatiniform exanthemas, urticaria, and edema after vitamin C use (Widenbauer 1936a,b). Positive skin reactions were reported by Rust (1954) in seven cases and by Panzani (1961) in one case. In this latter case, the skin test was a passive transfer test (Prausnitz-Kiistner) but the data presented are too scarce to demonstrate a definite immunological etiology of the observed reactions. The same holds for three cases of respiratory and cutaneous allergy reported recently by Vassal (1975). 

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