Serum Sickness-Like Reaction in Children: Review of the Literature

Abstract

Serum sickness-like reaction (SSLR) is an acute inflammatory condition affecting children and adults characterised by the development of erythematous skin lesions and joint swelling with or without fever. Although these features resemble the ones seen in patients with classic serum sickness, the precise pathophysiology of SSLR remains unclear. It is considered that drugs, usually β-lactam antibiotics, and some infectious agents can trigger an immunologic reaction that leads to these clinical manifestations. This condition is usually under-recognised or mistakenly diagnosed as other conditions (e.g., urticaria, urticaria multiforme, reactive arthritis, erythema multiforme) and therefore infrequently reported. Until now, there was no standardised treatment for this condition and controversy regarding the use of antihistamines, nonsteroidal anti-inflammatory drugs, and oral corticosteroids remains. Most of the current literature on SSLR is based on occasional case reports series. The main objective of this manuscript is to offer an organised and updated review of the clinical features and current treatment options for paediatric SSLR, useful for physicians and other health professionals with interest in paediatrics and adverse drug reactions.

Fever and Challenging Cutaneous Mimicked-Urticaria Reaction to Amoxicillin-Clavulanate in two Children

“…The wrist and ankles seem to be the most affected joints in children. 3 Skin rash is urticaria-like, but the itchiness is usually mild or absent, as in our patients. Rash morphology is variable, including macular exanthem, polycyclic rings, and annular pink-to-purple plaques of different sizes.…”

“…Serum sickness–like reaction frequently occurs in children under 5 years of age following the administration of antibiotics, mainly penicillin, although its precise prevalence is unknown, mainly because it is often confused with other drug reactions. 3 Cefaclor has been described as the main culprit agent, 4 but other beta-lactams have been implicated 5 and a wide variety of other drugs have been reported to trigger SSLR: anticonvulsants, anti-inflammatory and anticancer agents, griseofulvin, metronidazole, and biological agents. 3 In both our cases, the culprit agent was amoxicillin-clavulanate.…”

“…3 Cefaclor has been described as the main culprit agent, 4 but other beta-lactams have been implicated 5 and a wide variety of other drugs have been reported to trigger SSLR: anticonvulsants, anti-inflammatory and anticancer agents, griseofulvin, metronidazole, and biological agents. 3 In both our cases, the culprit agent was amoxicillin-clavulanate. Correlation of SSLR with hepatitis B and rabies vaccine and tetanus toxoid has also been observed, as well as with viral and bacterial infections.…”

Managing a Patient Presenting With Chest Pain and Gastrointestinal Complaints Using Dupilumab

“…Based on this patient's demographics, presentation, and past medical history, we considered acute appendicitis, acute gastroenteritis, mesenteric ischemia, bowel obstruction, pancreatitis, and an acute ADR [8]. Although serum sickness-like reaction (SSLR) and anaphylaxis may be triggered by medications, this patient lacked the signs and symptoms typical of these reactions like worsening rash, arthralgia, and difficulty breathing [9,10]. Thus, we pursued other possible causes of acute abdominal pain [8].…”

Drugs and the skin: A concise review of cutaneous adverse drug reactions

“…Its name was given to the clinical similarities with the classic SS, but now is considered that these are 2 different entities. 76 The skin rash is described as urticaria-like and is characterized by erythematous papules and macules of different sizes that evolve into annular lesions with/without purplish discoloration. However, unlike classic SS reaction, skin lesions in SSLR are not true urticaria as they are not transient but remain in the same area for several days (fixed).…”