Severe Serum Sickness-Like Reaction: Challenges in Diagnosis and Management

S, De Schryver; Netchiporouk, Elena; Ben‐Shoshan, Moshe

doi:10.4172/2155-9554.1000279

Cited by 5 publications

(1 citation statement)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…SSLR is a hypersensitivity reaction to an offending drug which typically has a delayed onset following antigen exposure. Symptoms typically include rash, fever, myalgias, lymphadenopathy, and arthritis, but differs from true serum sickness by lacking detectable circulating immune complexes or hypocomplementemia [5]. Laboratory findings include leukocytosis, elevated erythrocyte sedimentation rate (ESR), elevated CRP, and proteinuria.…”

Section: Discussionmentioning

confidence: 99%

Time After Time: A Second Look at Evolving Rash With Multiple Exposures to Amoxicillin

Nnomadim¹,

Speck²,

Vidaurri³

2021

Cureus

View full text Add to dashboard Cite

Pediatric penicillin drug reactions may present in many forms such as erythema multiforme, serum-sickness, serum-sickness-like reaction (SSLR), Henoch-Schonlein Purpura (HSP), and urticarial vasculitis. Here, we review the case of a 13-month-old with atypical presentation of a drug reaction with increasing severity after each exposure to amoxicillin. We discuss the various differential diagnoses in comparison to our patient's presentation and conclude with the recommendation of considering timing and previous exposures in the diagnosis of drug-associated rashes in pediatric population.

show abstract

Section: Discussionmentioning

confidence: 99%

Time After Time: A Second Look at Evolving Rash With Multiple Exposures to Amoxicillin

Nnomadim¹,

Speck²,

Vidaurri³

2021

Cureus

View full text Add to dashboard Cite

show abstract

Serum Sickness-Like Reaction Associated with Epstein – Barr Virus: Clinical Case

Ivanchikov

Мурашкин

Амбарчян

et al. 2022

Vopr. sovr. pediatr.

View full text Add to dashboard Cite

Background. Annular dermatoses are a group of diseases with major clinical manifestation of rashes of relevant form. This manifestation pattern causes difficulties in diagnosis. The case of rarely diagnosed annular dermatosis is presented: serum siknesslike reaction (SSLR) triggered by the Epstein – Barr virus (EBV). Clinical case description. Patient D., 8 years old girl, noted abdominal pain 3 weeks before hospitalization, and later numerous polymorphic rashes (erythematous macules, urticarial elements), swelling and pain in joints. Self-treatment with non-steroidal anti-inflammatory and systemic antihistamines did not lead to any improvement. The patient was hospitalized in the pediatric department at the place of residence, where the diagnosis “Henoch-Schonlein purpura, mixed type” was established according to the results of physical, laboratory (double increase of ALT and AST, ESR up to 166 mm/h, IgM to EBV), and ultrasound (mesenteric lymph nodes hyperplasia) studies. Systemic glucocorticosteroids have led to improvement, however, few days after the end of the treatment there was relapse of rash and arthralgia. Thus, the girl was administrated to clinical diagnostic center. Patient’s general condition was satisfactory at the time of examination. There were numerous erythematous annular urticarial and macular elements (3–12 cm) on the skin of face, body and limbs. Some foci, as well as some resolved rashes had blue spots with indistinct boundaries that disappeared after compression. Mucous membranes, nails and hair were intact. Subjective symptoms — slight burning around rashes, at palpation — low-intensity pain in the left radiocarpal joint. Blood tests: C-reactive protein concentration increased up to 12 mg/L, ESR up to 26 mm/h, IgG to EBV up to 47.7. Conclusion. During differential diagnosis we should consider the possibility of SSLR development in all pediatric patients with annular rashes associated with arthralgia and/or arthritis, fever, history of drug use (most often beta-lactam antibiotics), recent vaccination or manifestations of viral infection, especially in case of cyanotic spots after rashes resolution and non-specific laboratory parameters.

show abstract

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

Pozzo‐Magaña

Lazo‐Langner

2019

EMJ Dermatol

View full text Add to dashboard Cite

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.

show abstract

Severe Serum Sickness-Like Reaction: Challenges in Diagnosis and Management

Cited by 5 publications

References 14 publications

Time After Time: A Second Look at Evolving Rash With Multiple Exposures to Amoxicillin

Time After Time: A Second Look at Evolving Rash With Multiple Exposures to Amoxicillin

Serum Sickness-Like Reaction Associated with Epstein – Barr Virus: Clinical Case

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

Contact Info

Product

Resources

About