Cases reported "Serum Sickness"

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1/76. serum sickness-like syndrome due to mosquito bite.

    Local inflammatory reactions at the site of a mosquito bite are frequent. Immediate systemic reactions have occasionally been reported. The first case of a patient with relapsing episodes of a serum sickness-like syndrome following mosquito bites is reported herein. A 62-year-old patient came to the emergency room complaining of sudden malaise, chills, fever, headache, cervical lymph node enlargement, arthromyalgia, generalized purpura and leukopenia 6 h after a mosquito bite. He had experienced multiple similar episodes in the last 20 years, also following mosquito bites. Infectious and autoimmune diseases were ruled out. Serum IgE was 9,102 kU/l. Prick test of whole-body culex pipiens extract was positive. Specific IgE to aedes communis was 2.25 kU/l. SDS-PAGE immunoblotting of the patient's serum with whole-body C. pipiens extract revealed 43 and 17 kDa IgG-binding proteins and 22 and 17 kDa IgE-binding proteins, neither of which were found with control sera. skin biopsy was consistent with leukocytoclastic vasculitis. The presence of both mosquito-specific IgE and IgG in the patient's serum suggest a possible cooperative immune response leading to clinical manifestations of serum sickness. ( info)

2/76. bupropion hydrochloride induced serum sickness-like reaction.

    BACKGROUND: bupropion hydrochloride is used frequently in the treatment of depression and in smoking cessation therapy. methods: We report a case of bupropion hydrochloride induced serum sickness-like reaction. RESULTS: There was complete resolution of symptoms on discontinuing bupropion and instituting therapy with prednisone and antihistamines. CONCLUSION: This case is seemingly the first report of a serum sickness-like reaction to bupropion hydrochloride. ( info)

3/76. serum sickness induced by bupropion.

    OBJECTIVE: To describe the first reported case of serum sickness induced by exposure to bupropion. CASE SUMMARY: bupropion was administered to a 45-year-old white man being treated for depression with psychosis. Within 24 hours after his first dose of bupropion, the patient became delirious and then developed fever, myalgia, arthralgia, and a rash. bupropion was discontinued after the second dose. With supportive measures, symptoms remitted over two weeks. DISCUSSION: A thorough search for other etiologies of the patient's symptoms was unrevealing, and a clinical diagnosis of serum sickness was made. Given the temporal association between the illness and the introduction of bupropion, this was felt to be the causal agent. No previous reports of serum sickness induced by bupropion were found in the literature. CONCLUSIONS: The previously unreported adverse drug reaction of serum sickness associated with the use of bupropion is demonstrated by this case, based on the temporal relationship and the results of stopping the drug, in light of no other identifiable etiology. ( info)

4/76. bupropion-induced serum sickness-like reaction.

    OBJECTIVE: To report three cases of serum sickness-like reaction (SSLR) associated with bupropion ingestion. CASE SUMMARY: A 27-year-old woman, a 46-year-old man, and a 43-year-old woman presented to our emergency department within a three-week period with symptoms consistent with SSLR. Symptoms consisted of pruritic skin rash, tongue swelling, and arthralgias. All three patients had initiated bupropion therapy within two to three weeks prior to arrival. DISCUSSION: This is the second published case describing SSLRs associated with bupropion. Reports of urticaria and rash with bupropion use are numerous and the incidence has been estimated at between 1% and 4%. arthralgia and arthropathy with bupropion use are reported much less commonly. The onset of symptoms of SSLRs typically begins six to 21 days after administration of the causative agent. SSLRs are usually self-limiting, lasting four to 14 days. CONCLUSIONS: SSLRs following bupropion ingestion appear to be rare. However, the fact that this cluster of patients presented to our emergency department within a three-week period suggests that this reaction may be underreported. ( info)

5/76. Severe serum sickness-like reaction to oral penicillin drugs: three case reports.

    BACKGROUND: Because the use of heterologous sera has diminished, the incidence of serum sickness has declined. However, serum sickness-like reactions to nonprotein drugs continue to occur. methods: We report three cases of severe serum sickness-like reactions in adults to oral penicillin drugs. RESULTS: In each patient, significant symptom resolution occurred within 24 hours of starting therapy with oral corticosteroids. CONCLUSIONS: serum sickness-like reactions to oral penicillin drugs may be more common than reported in the literature and can be very severe. No specific laboratory finding is universally present or definitively diagnostic. As with classic serum sickness, the diagnosis of serum sickness-like reaction is made clinically. In severe cases such as those presented here with debilitating joint symptoms or life-threatening angioedema, a diagnostic-therapeutic trial of prednisone, 40 to 60 mg at least once daily, is warranted. ( info)

6/76. Childhood serum sickness: a case report.

    Childhood serum sickness is a rare allergic disease that follows the administration of a foreign antigenic material, most commonly caused by injecting a protein or haptenic drug. The disease is a type III hypersensitivity reaction mediated by deposits of circulating immune complexes in small vessels, which leads to complement activation and subsequent inflammation. The clinical features are fever, cutaneous eruptions, lymphadenopathy, arthralgias, albuminuria, and nephritis. serum sickness is an acute self-limited disease. We report a 3-year-old child who presented with fever and a rash; an invasive bacterial infection was strongly suspected. He was therefore given penicillin and gentamicin and responded well. At day 4 after admission, he developed a serum sickness reaction and showed symptoms of arthralgias, generalized edema, purpura, and gross hematuria. The white blood cell count was 12 190/mm3 with 7% eosinophils. urinalysis revealed red blood cell above 100 per high power field, white blood cell 10 to 15 per high power field, and proteinuria. The antibiotics were discontinued and hydrocortisone (20 mg/kg/d), diphenhydramine HCl (4 mg/kg/d), aspirin (66 mg/kg/d) was administered, plus 1 dose of epinephrine (0.01 mL/kg) administered intramuscularly. On day 7, the 3rd day after withholding antibiotics, his condition dramatically improved. The clinical symptoms resolved progressively and his urinalysis returned to normal. ( info)

7/76. Diphenylhydantoin-induced serum sickness with fibrin-platelet thrombi in lymph node microvasculature.

    In this 16 year old boy a syndrome, characterized by high fever, generalized lymphadenopathy, splenomegaly, diffuse skin rash, facial and periorbital edema, neutropenia, thrombocytopenia, elevated serum glutamic oxaloacetic transaminase (SGOT) levels and transient electrocardiographic changes, appeared 2 weeks after the institution of diphenylhydantoin therapy. Lymph node biopsy, performed at the height of the illness, revealed widespread subendothelial fibrin exudation and fibrin-platelet thrombi in the lymph node microvasculature, a finding most consistent with thrombotic thrombocytopenic purpura. Although many types of abnormal lymph node histology have been described with diphenylhydantoin, this appears to be the first instance of this histologic picture. This syndrome may be related to a serum sickness-like illness which triggered an episode of localized coagulopathy. ( info)

8/76. Immunohistochemical analysis of human serum sickness glomerulonephritis.

    AIM: To analyze pathological and immunohistochemical characteristics of glomerulonephritis in human serum sickness. methods: Renal biopsy specimens from two female patients with serum sickness that ensued after application of anti-lymphocyte horse globulin for aplastic anemia were analyzed by light microscopy, immunofluorescence, and electron microscopy. To prove the depositions of foreign protein, frozen sections were incubated with fluorescein-conjugated anti-horse protein serum. Immunohistochemical analysis was performed on B5-fixed paraplast-embedded tissue or frozen acetone-fixed sections with the primary antibodies for molecules/cell markers CD35, CD43, CD45RO, CD68, CD2, lysozime, L26, and S100. RESULTS: Diffuse proliferating and necrotizing glomerulonephritis with crescents was found. There were coarse granular mesangial, subepithelial, subendothelial, and intramembranaceous deposits of mainly horse globulin, C3, and IgG. Most mesangium infiltrating cells were macrophages and t-lymphocytes. Electron microscopy revealed hypertrophy of podocytes, but immunohistochemistry did not show their normal CD35 (C3b-receptor) staining. Apart from epithelial cells, main crescent forming cells were macrophages and t-lymphocytes. Rare dendritic cells and abundant infiltration of macrophages, t-lymphocytes, and neutrophiles were found in the interstitium. CONCLUSION: In severe serum sickness, glomeruli and tubuli are destroyed beyond the range usually seen in other types of glomerulonephritis caused by immune complexes, except in cases with widespread crescents. hypertrophy of podocytes and loss of their normal C3b-receptor staining has not yet been described in the literature. C3b-receptors on podocytes could play a role in pathogenesis of glomerular injury caused by immune complexes. ( info)

9/76. biology and treatment of the mamba snakebite.

    Mambas are venomous African snakes that are capable of inflicting fatal envenomation. The mambas (genus Dendrosaspis) are members of the family elapidae [1]. Four species of mamba inhabit equatorial and southern africa. Without medical treatment, mamba bites are frequently fatal. first aid treatment includes lymphatic retardation with immobilization and pressure wrap. Medical management requires the intravenous administration of mamba-specific antivenin. ( info)

10/76. serum sickness-like reactions.

    A serum sickness-like reaction (SSLR) to drug administration usually consists of cutaneous rash, arthralgia/arthritis, and, often, fever. This entity rarely has been discussed in the dermatologic literature. We describe the case of a 3-year-old girl with urticaria, fever, and arthralgia that appeared 8 days after starting cefaclor therapy for otitis media. ( info)
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