1 Pediatric Infectious Diseases Unit
2 Immunoallergology Department Hospital Dona Estefânia – CHLC - EPE, Lisbon, Portugal
Poster/Internacional
Background and aims: Serum sickness-like reactions (SSLR) in children after the administrations of antibiotics, although rare in clinical practice, has long been identified. The main purpose of this study was to assess the importance of considering diagnosis of SSLR in childhood.
Methods: Review of the cases of SSLR admitted to our unit between 2002 and 2012. The diagnosis was based on clinical findings, exclusion of infectious etiology and history of exposure to antibiotics (about two weeks before)
Results: Six children, aged from 15 months to 17 years (median age 3), were observed at emergency department with fever, pruritic rash and arthralgia/arthritis. None presented enathem. Epstein-Barr virus, citomegalovirus, parvovirus B19, enterovirus, influenza, adenovirus, Mycoplasma, Clamydia and Streptococcus pyogenes infections were excluded. All the patients had been exposed to an antibiotic within 7 to 21 days (median 12.5 days) before the admission: amoxicillin-clavulanate (33%), amoxicillin (33%), cefaclor (16%) and minocycline (16%). Mild proteinuria was present in one-third of the children, serum complement levels were abnormal in 16% of cases and circulating immune complexes were negative. All were treated with antihistamines, 33% and 66% needed a short course of glucocorticoids.
Conclusions: Although there may be analytic alterations like hypocomplementemia or renal dysfunction, their absence does not exclude this diagnosis. In most cases, the diagnosis is clinical, with the characteristic pattern of rash, fever and arthralgia, and can be confirmed after the exclusion of infectious causes.