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Plante ER, Ekwunwa C, Maciag MC, Illanes D. Serum sickness-like reaction to D-supplement: a case report. BMC Pediatr 2024; 24:404. [PMID: 38909179 PMCID: PMC11193288 DOI: 10.1186/s12887-024-04753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/10/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Serum Sickness-Like Reaction (SSLR) is an immune response characterized by rash, polyarthralgias, inflammation, and fever. Serum sickness-like reaction is commonly attributed to antibiotics, anticonvulsants, and anti-inflammatory agents. CASE PRESENTATION A 16-year-old female with a history of overactive bladder and anemia presented with a diffuse urticarial rash, headaches, joint pain, and swelling for three days. Her medications included oral contraceptive pills, iron, mirabegron, UQora, and a probiotic. Physical examination revealed a diffuse urticarial rash, and her musculoskeletal exam revealed swelling and tenderness in her wrists. She was evaluated by her pediatrician and started on a 7-day course of prednisone, as well as antihistamines. Her CBC, basic metabolic panel, liver function panel, Lyme titers, and urinalysis were all within normal limits. With concern for hypersensitivity reaction to medication, all medications were discontinued. Nine days after symptom onset, the patient was evaluated by an allergist, who confirmed her presentation was consistent with serum sickness-like reaction. Her symptoms resolved, and her medications were re-introduced sequentially over several months. Restarting UQora, however, triggered a recurrence of her symptoms, and it was identified as the culprit medication. Consequently, UQora was permanently discontinued, and the patient has remained symptom-free. CONCLUSIONS This case report describes the first documented case of serum sickness-like reaction caused by UQora (active ingredient D-mannose). D-mannose is a monosaccharide, and it is frequently promoted to prevent urinary tract infections. While the clinical features and timeline in this case were typical of serum sickness-like reaction, UQora as the trigger was highly unusual. Clinicians should be aware of the diverse triggers of serum sickness-like reaction and the importance of prompt identification and management to enhance patient safety. Further research is necessary to better understand the potential therapeutic applications of D-mannose, as well as the potential risks and interactions.
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Affiliation(s)
- Emma R Plante
- Department of Gynecology and Urogynecology, Milford Regional Medical Center, 14 Prospect Street, Milford, MA, 01757, USA.
| | - Charles Ekwunwa
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| | - Michelle C Maciag
- Asthma and Allergy Affiliates, 114R Highland Ave, Salem, MA, 01970, USA
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Diego Illanes
- Department of Gynecology and Urogynecology, Milford Regional Medical Center, 14 Prospect Street, Milford, MA, 01757, USA
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2
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Surdacki M, Fernandez E, Phillips EJ, Stone CA. Drugs associated with serum sickness and serum sickness-like reactions: A review of FDA Adverse Event Reporting System (FAERS) data. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1351-1354.e1. [PMID: 38462072 DOI: 10.1016/j.jaip.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Madeline Surdacki
- University of Tennessee Health Science Center College of Medicine, Memphis, Tenn
| | - Edward Fernandez
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth J Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
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3
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Alzaidi AA, Alzaidi AA, AlOtaibi MT, Alsheikh RM. Case Report of Serum Sickness-like Reaction following the First Dose of the Chimpanzee Adenovirus-Vectored AstraZeneca COVID-19 Vaccine, ChAdOx1. Vaccines (Basel) 2023; 11:vaccines11020467. [PMID: 36851343 PMCID: PMC9963129 DOI: 10.3390/vaccines11020467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Serum sickness-like reaction from serum sickness is critical. Serum sickness-like reaction has comparable symptoms to serum sickness, but their underlying pathophysiology is distinct. This delayed hypersensitivity response was first characterized as a drug-induced reaction and is uncommon in adults; it is more common in children. COVID-19 vaccinations are now being routinely given in the COVID-19 period, and adverse reactions to immunization have been recorded. We present a case of COVID-19 vaccination-induced serum sickness-like reaction which developed after receiving the first dose of AstraZeneca COVID-19 vaccine.
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Affiliation(s)
- Areej Awad Alzaidi
- Family Medicine, Family Medicine Department, Ministry of the National Guard—Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah 21423, Saudi Arabia
- Correspondence: ; Tel.: +966-567-254-046
| | - Arwa Awad Alzaidi
- Medical Laboratory Specialists, Maternity and Children Hospital, Ministry of Health, Makkah 24246, Saudi Arabia
| | | | - Reem M. Alsheikh
- Family Medicine, Family Medicine Department, Ministry of the National Guard—Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah 21423, Saudi Arabia
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4
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Triwatcharikorn J, Pholmoo N, Ratanasutiranont N, Rerknimitr P, Klaewsongkram J. Skin testing might have a diagnostic role in immune complex-mediated hypersensitivity reactions. Clin Exp Dermatol 2023; 48:27-30. [PMID: 36669172 DOI: 10.1093/ced/llac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 01/09/2023]
Abstract
Clinical applications of skin testing are known to help diagnose IgE-mediated and T-cell-mediated delayed cutaneous reactions. By contrast, drug-induced immune complex-mediated vasculitis is primarily diagnosed based on medical history, clinical setting and laboratory evidence of immune-complex formation, as there are no proven methods to identify the suspect culprit. We report three cases of drug- or biologic-induced immune complex-mediated vasculitis, in which the culprit agents could be confirmed by a positive intradermal test with later reading (between 12 and 24 h after the test), with verification by immunohistochemical or immunofluorescent results. The findings of our study suggest that skin tests with a delayed reading could have a potential role in diagnosing some instances of immune complex-mediated hypersensitivity reactions.
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Affiliation(s)
- Jidapa Triwatcharikorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Natthiya Pholmoo
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Narumol Ratanasutiranont
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Pawinee Rerknimitr
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Jettanong Klaewsongkram
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
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5
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Ivanchikov VV, Murashkin NN, Ambarchian ET, Kuzminova AD. Serum Sickness-Like Reaction Associated with Epstein – Barr Virus: Clinical Case. CURRENT PEDIATRICS 2022. [DOI: 10.15690/vsp.v21i5.2455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- V. V. Ivanchikov
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - N. N. Murashkin
- National Medical Research Center of Children’s Health; Central State Medical Academy of Department of Presidential Affairs
| | - E. T. Ambarchian
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
| | - A. D. Kuzminova
- Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery
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6
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Guarnieri KM, Xie SS, Courter JD, Liu C, Ruddy RM, Risma KA. Distinct Characteristics and Chronology of Amoxicillin-Associated Reactions in Pediatric Acute Care Settings. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2951-2957.e3. [PMID: 35872212 DOI: 10.1016/j.jaip.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Amoxicillin-associated reactions (AARs) in children presenting as rashes are common, and recent data suggest that >90% tolerate amoxicillin on re-exposure. However, additional data would help pediatricians and allergists gain confidence in referring and testing children who experienced systemic symptoms perceived as "worrisome," thus leading to urgent medical evaluations. By characterizing the entire spectrum of AAR symptoms in pediatric patients presenting to emergency department (ED)/urgent care (UC) settings, we sought to increase our diagnostic acumen to guide subsequent allergy evaluations. OBJECTIVE To fully characterize clinical features of rash and systemic symptoms in children presenting to the ED/UC with AARs. METHODS A retrospective chart review of children seen in the ED/UC from July 1, 2015, to June 30, 2017, was conducted. Clinical features, chronology, and seasonality were detailed, and cases were classified into 3 previously described AAR phenotypes: maculopapular exanthem (MPE), urticaria, and serum sickness-like reactions (SSLRs), if they experienced joint symptoms. RESULTS Children (n = 668; median age: 1.8 years) presented to the ED/UC with urticaria (44%), MPE (36%), and SSLRs (11%) typically on days 7 to 10 of amoxicillin. Although children with SSLRs were more frequently treated with corticosteroids (28%, P < .0001) and exhibited higher rates of "worrisome" features (fever, angioedema, or gastrointestinal symptoms; 73%, P < .0001), delayed-onset systemic symptoms were identified frequently in all 3 groups. ED/UC reutilization was unexpectedly high with 66 children (10%) returning to the ED/UC for re-evaluation. CONCLUSION "Worrisome" symptoms are common in children presenting to the ED/UC with AARs. Future studies are needed to determine the impact on subsequent referral and allergy testing.
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Affiliation(s)
- Katharine M Guarnieri
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susan S Xie
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua D Courter
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard M Ruddy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kimberly A Risma
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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7
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Abstract
Annular urticarial configurations are often associated with acute and chronic urticaria. Such lesions may be short-lived, migratory, transient, pruritic, and resolving with no residual evidence, making the diagnosis of urticaria an obvious one. Annular urticarial lesions can be the presenting signs of various cutaneous and systemic diseases. The differentiation of urticarial lesions may be made by considering the duration of an individual lesion longer than 24 hours, with burning and pain sensation in the lesions or lack of pruritus; skin marks such as postinflammatory pigmentation or purpura after resolution of the lesions; associated scaling or vehiculation in the lesions; systemic symptoms such as arthralgia, fever or fatigue; and several abnormal laboratory findings. The main differential diagnoses of annular urticarial lesions include urticarial vasculitis, autoinflammatory syndromes, hypersensitivity reactions, and connective tissue diseases.
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8
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Del Pozzo-Magaña BR, Abuzgaia A, Murray B, Rieder MJ, Lazo-Langner A. Paediatric serum sickness-like reaction: A 10-year retrospective cohort study. Paediatr Child Health 2021; 26:428-435. [PMID: 34777661 DOI: 10.1093/pch/pxab003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
Background Serum sickness-like reaction (SSLR) is an acute inflammatory condition affecting predominantly children. The pathophysiology remains unclear, but drugs are considered the main trigger. Objective The aim of this study was to describe the clinical and laboratory features, triggers, and treatment modalities in children diagnosed with SSLR. Methods We conducted a 10-year retrospective cohort study including all paediatric patients (0 to 18 years old) with query SSLR referred to the Adverse Drug Reactions Clinic at the Children's Hospital of Western Ontario. Diagnostic criteria included acute skin rash plus joint inflammation with or without fever. Results We included 83 patients (47 females). Age ranged from 11 months to 12 years (mean 3.2 years). Amoxicillin was the trigger in 82.7% of patients. The mean time between the exposure to the triggering drug and the development of the symptoms was 8.5 days. Urticaria-like and Erythema multiforme-like lesions were present in 35% and 38.5% of the cases, respectively. Joint inflammation affecting hands/feet was present in 60%. Pruritus, lip/eye swelling, and fever were reported in 33, 31, and 45% of patients, respectively. The lymphocyte toxicity assay (LTA) showed incremental T-cell toxicity in 32 of 34 patients. Children that received treatment with antihistamines/nonsteroidal anti-inflammatory drugs (NSAIDs) plus oral steroids had a mean recovery time shorter than those treated only with antihistamines/NSAIDs (6 versus 8 days; P=0.09). Conclusions In our study, SSLR was mostly triggered by amoxicillin and had a mean time presentation of 8.5 days. Further prospective and well-conducted studies are needed.
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Affiliation(s)
- Blanca R Del Pozzo-Magaña
- Department of Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada.,Division of Clinical Pharmacology, Western University and London Health Sciences Centre, London Ontario, Canada
| | - Awatif Abuzgaia
- Department of Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada.,Division of Clinical Pharmacology, Western University and London Health Sciences Centre, London Ontario, Canada
| | - Barbara Murray
- Department of Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada.,Division of Clinical Pharmacology, Western University and London Health Sciences Centre, London Ontario, Canada
| | - Michael J Rieder
- Department of Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada.,Division of Clinical Pharmacology, Western University and London Health Sciences Centre, London Ontario, Canada
| | - Alejandro Lazo-Langner
- Department of Medicine, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
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9
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Bez Y, Coffey BJ. Fluoxetine-Induced Serum Sickness-Like Reaction in an Adolescent with Obsessive Compulsive Disorder and Diabetes. J Child Adolesc Psychopharmacol 2021; 31:646-649. [PMID: 34784233 DOI: 10.1089/cap.2021.29211.bjc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yasin Bez
- Department of Psychiatry, Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Barbara J Coffey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
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10
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Kayser F, Fourneau H, Mazy OC, Mazy S. Breast implant seroma: A SARS-CoV-2 mRNA vaccine side effect. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:984-986. [PMID: 34405902 PMCID: PMC8426943 DOI: 10.1002/jcu.23056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/30/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
Fluid collection surrounding breast implants, called seroma, is a frequent issue that has diverse etiologies. We describe a 48-year-old woman with an acute onset of bilateral breast swelling occurring 5 years after aesthetic surgery and 10 days after a second SARS-CoV-2 mRNA vaccine dose. At breast ultrasound, we found an abundant bilateral peri-implant seroma. Our patient noticed symptom improvement 48 h after nonsteroidal anti-inflammatory drug treatment, complete disappearance of symptoms after 10 days with seroma disappearance documented by ultrasound. We hypothesized a breast implant seroma as post-SARS-CoV-2 mRNA vaccine side effect, as different other diagnosis had been excluded.
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Affiliation(s)
- Françoise Kayser
- Université catholique de LouvainCHU UCL Namur, Department of RadiologyAvenue G Thérasse 1, 5530YvoirBelgium
| | - Hadrien Fourneau
- Université catholique de LouvainCHU UCL Namur, Department of RadiologyAvenue G Thérasse 1, 5530YvoirBelgium
| | - Olivier C. Mazy
- Department of Pharmacy, Faculty of MedicineUniversité de Namur (UNamur)NamurBelgium
| | - Stéphane Mazy
- Université catholique de LouvainCHU UCL Namur, Department of RadiologyPlace L Godin 15, 5000NamurBelgium
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Galvão Dos Santos de Araujo AC, Moura de Almeida L, Moura de Almeida AP, Fontenelle de Oliveira E, Carrijo Rochael M, Aires de Morais R, Rezende HD. Serum Sickness-Like Reaction: Drug-Induced Cutaneous Disease in a Child. Dermatol Pract Concept 2021; 11:e2021029. [PMID: 34413998 DOI: 10.5826/dpc.1103a29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Liana Moura de Almeida
- Álvaro Alvim School Hospital. Department of Dermatology. Campos dos Goytacazes, Rio de Janeiro, Brazil
| | | | - Elisa Fontenelle de Oliveira
- Fernandes Figueira Institute/FIOCRUZ. Department of Pediatric Dermatology. Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mayra Carrijo Rochael
- Fluminense Federal University. Department of Pathology. Niterói, Rio de Janeiro, Brazil
| | | | - Hudson Dutra Rezende
- Álvaro Alvim School Hospital. Department of Dermatology. Campos dos Goytacazes, Rio de Janeiro, Brazil
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12
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Lamontagne SJ, Pizzagalli DA, Olmstead MC. Does inflammation link stress to poor COVID-19 outcome? Stress Health 2021; 37:401-414. [PMID: 33315291 DOI: 10.1002/smi.3017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/03/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19) continues to ravage communities across the world. Despite its primary effect on the respiratory system, the virus does not solely impact those with underlying lung conditions as initially predicted. Indeed, prognosis is worsened (often fatal) in patients with pre-existing hyperinflammatory responses (e.g., hypertension, obesity and diabetes), yet the mechanisms by which this occurs are unknown. A number of psychological conditions are associated with inflammation, suggesting that these may also be significant risk factors for negative outcomes of COVID-19. In this review, we evaluate preclinical and clinical literature suggesting that chronic stress-induced hyperinflammation interacts synergistically with COVID-19-related inflammation, contributing to a potentially fatal cytokine storm syndrome. In particular, we hypothesize that both chronic stress and COVID-19-related hyperinflammation are a product of glucocorticoid insufficiency. We discuss the devastating effects of SARS-CoV-2 on structural and functional aspects of the biological stress response and how these induce exaggerated inflammatory responses, particularly interleukin (IL)-6 hypersecretion. We postulate that chronic stress should be considered a significant risk factor for adverse COVID-19-related health outcomes, given overlapping peripheral and central immune dysregulation in both conditions. We conclude by discussing how people with a history of chronic stress could mitigate their risk for COVID-19 complications, identifying specific strategies that can be implemented during self-isolation.
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Affiliation(s)
- Steven J Lamontagne
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.,Center for Depression, Anxiety and Stress Research, McLean Hospital/Harvard Medical School, Belmont, Massachusetts, USA
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital/Harvard Medical School, Belmont, Massachusetts, USA
| | - Mary C Olmstead
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
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13
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Brennan S, Marmor I, Schafer C, Ko J, Torres Garcia JA, Rosman IS, Coughlin C, Coverstone A, White AJ. Serum sickness-like reaction following initiation of elexacaftor/tezacaftor/ivacaftor therapy. Pediatr Pulmonol 2020; 55:2846-2847. [PMID: 32956574 DOI: 10.1002/ppul.25072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Steven Brennan
- Edward Mallinckrodt Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University, St. Louis, Missouri, USA
| | - Itay Marmor
- Edward Mallinckrodt Department of Pediatrics, Division of Rheumatology, Washington University, St. Louis, Missouri, USA
| | - Christine Schafer
- Department of Internal Medicine, Division of Dermatology, Washington University, St. Louis, Missouri, USA
| | - James Ko
- Department of Internal Medicine, Division of Dermatology, Washington University, St. Louis, Missouri, USA
| | - José A Torres Garcia
- Edward Mallinckrodt Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University, St. Louis, Missouri, USA
| | - Ilana S Rosman
- Department of Internal Medicine, Division of Dermatology, Washington University, St. Louis, Missouri, USA.,Department of Immunology and Pathology, Washington University, St. Louis, Missouri, USA
| | - Carrie Coughlin
- Department of Internal Medicine, Division of Dermatology, Washington University, St. Louis, Missouri, USA
| | - Andrea Coverstone
- Edward Mallinckrodt Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University, St. Louis, Missouri, USA
| | - Andrew J White
- Edward Mallinckrodt Department of Pediatrics, Division of Rheumatology, Washington University, St. Louis, Missouri, USA
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14
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Affiliation(s)
- Adam Cohen
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Asha Morrow
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Meghan McClure
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
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15
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Mohsenzadeh A, Movahedi M, Saatchi M, Parvaneh N, Shariat M, Aghamohammadi A, Gharagozlou M. Serum sickness-like reactions in Iranian children: a registry-based study in a referral center. Allergol Immunopathol (Madr) 2020; 48:424-429. [PMID: 32653225 DOI: 10.1016/j.aller.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Considering that no studies have been done on a comprehensive review of Serum sickness-like reactions patients (SSLRs) at a referral center in Iran so far, this study aimed to determine the clinical and laboratory characteristics of children with SSRL in Tehran Children's Medical Center. PATIENTS The present study was a registry-based study in which the data of 94 SSLRs patients registered in a two-year period were investigated. Confirmation of fever, rash, urticaria, arthralgia / arthritis and history of antibiotic consumption up to three weeks before were the criteria for the diagnosis. RESULTS Fifty-one (54 %) patients were male with mean age of 56 ± 30 months and there was no significant difference in the age of the two genders. The mean onset of symptoms before hospitalization were 3.8 ± 2.7 days (1-14 days); this mean was significantly higher in males than in females (4.6 ± 2.9 versus 2.9 ± 1.7 days, P-value = 0.003). Among antibiotics, Co-amoxiclav and Cefixime antibiotics had the most frequency by 31 % and 33 %, respectively as the most important incidence factor of SSLRs. The mean duration of consumption of culprit medications in the incidence of SSLRs was 5.6 ± 2.9 days with a range of 1-15 days. CONCLUSIONS This study showed that among the antibiotics, Co-amoxiclav and Cefixime are more prevalent and a review of prescribing these two antibiotics for the treatment of the children's infections is essential if this finding is confirmed by other Iranian scholars.
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16
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McNamara K, Hughes OB, Strowd LC. Cutaneous drug eruptions including serum sickness-like reaction, symmetrical drug-related intertriginous and flexural exanthema, and drug-induced lupus. Clin Dermatol 2020; 38:641-647. [PMID: 33341198 DOI: 10.1016/j.clindermatol.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cutaneous manifestations of drug reactions are common yet vary widely in their appearance and degree of internal organ involvement. Serum sickness--like reactions, symmetrical drug-related intertriginous and flexural exanthem, granulomatous drug eruption, pseudolymphoma, and drug-induced lupus are medication-induced conditions with dermatologic presentations. Many of the conditions discussed are relatively rare but nonetheless demand our attention and understanding. Some of the conditions presented may be more likely encountered in the hospital setting, as is the case with serum sickness-like reactions and drug-induced lupus, whereas others may present to outpatient clinic for diagnosis. Given the similarities in clinical history of patients presenting with these conditions, an understanding of the clinical presentation, pathophysiology, culprit medications, histologic appearance, and serologic characteristics is warranted to correctly diagnose and manage these uncommon adverse reactions. We also discuss how to differentiate some of these conditions from more serious mimickers, as in the case of pseudolymphoma drug reaction mimicking a true lymphoma and drug-induced lupus mimicking acute systemic lupus erythematosus.
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Affiliation(s)
- Kyle McNamara
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA
| | - Olivia Bosshardt Hughes
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA
| | - Lindsay Chaney Strowd
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA.
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Abstract
Drug eruptions in children are common but in general less studied than their adult counterparts. Aside from having significant impact on the child's health and quality of life, these reactions can limit what medications the patient can receive in the future. Familiarity with pediatric drug eruptions is important for accurate diagnosis and to prevent future recurrence or ineffective therapy. Our current understanding of how drug reactions differ mechanistically between children and adults is poor. There are multiple factors that could be contributing to the differing incidence, presentation, and treatment modalities offered to pediatric versus adult patients. For many of these cutaneous drug reactions, the treatment regime is not standardized, being based primarily on case reports. Although not comprehensive, this review highlights common pediatric drug eruption patterns and discuss diagnostic mimickers. Five cutaneous adverse drug reactions in the pediatric population are presented: morbilliform (exanthematous) eruptions, urticarial eruptions, serum sickness-like reactions, fixed drug eruptions, and DRESS syndrome. Clinical features, diagnostic workup, and management are discussed with an emphasis on the pediatric population.
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Affiliation(s)
- EmilyD Nguyen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Colleen K Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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18
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Gelincik A, Cavkaytar O, Kuyucu S. An Update on the Management of Severe Cutaneous Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3881-3901. [DOI: 10.2174/1381612825666191106115556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/01/2019] [Indexed: 12/15/2022]
Abstract
Severe cutaneous drug hypersensitivity reactions involve of different mechanisms , some of which are
life-threatening, such as Stevens-Johnson syndrome/toxic epidermal necrolysis, drug reaction with eosinophilia
and systemic symptoms, acute generalized exanthematous pustulosis, generalized bullous fixed drug eruptions,
serum sickness and serum sickness-like reaction and drug-induced vasculitis. These reactions may have substantial
morbidity and mortality. In the past years, successive studies have provided new evidence regarding the
pathogenesis of some of these severe reactions and revealed that underlying mechanisms are highly variable.
Since these reactions have unique presentations and distinct pathomechanisms, the treatment methods and response
rates might be different among various entities. Although supportive and local therapies are sufficient in
some of these reactions, targeted immunosuppressive treatments and even mechanistic therapies such as plasmapheresis
may be required in severe ones. However, there is still insufficient evidence to support the best treatment
options for these patients since number of patients and large-scale studies are limited. In this review, conventional
and new treatment options for severe cutaneous drug hypersensitivity reactions are presented in detail in
order to provide the contemporary approaches to lessen the morbidity and mortality relevant to these severe iatrogenic
diseases.
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Affiliation(s)
- Aslı Gelincik
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Semanur Kuyucu
- Department of Pediatric Allergy and Immunology, Mersin University, Faculty of Medicine, Mersin, Turkey
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19
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Guvenir H, Arikoglu T, Vezir E, Misirlioglu ED. Clinical Phenotypes of Severe Cutaneous Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3840-3854. [PMID: 31696807 DOI: 10.2174/1381612825666191107162921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022]
Abstract
Drug hypersensitivity reactions are clinically heterogenous ranging from mild to severe. Most drug hypersensitivity reactions are accompanied by cutaneous manifestations. Fever, mucous membrane involvement, large blisters, facial oedema, pustulosis and visceral involvement are clinical features that lead to suspicion of severe adverse drug reactions. Severe cutaneous adverse drug reactions (SCARs) include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis. Serum sickness like reactions, drug induced vasculitis and generalized bullous fixed drug eruptions are less severe clinical entities. SCARs are uncommon but associated with significant morbidity and mortality. Physician should be aware of specific red flags and danger signs to immediately identify these reactions. Immediate drug withdrawal is mandatory. Early diagnosis and appropriate treatment significantly affect the prognosis of the disease. The purpose of our review is to discuss clinical phenotypes of severe cutaneous drug hypersensitivity reactions.
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Affiliation(s)
- Hakan Guvenir
- Department of Pediatric Allergy and Immunology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Tugba Arikoglu
- Department of Pediatric Allergy and Immunology, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Emine Vezir
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emine Dibek Misirlioglu
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
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Arnold KA, Gao J, Stein SL. A review of cutaneous hypersensitivity reactions in infants: From common to concerning. Pediatr Dermatol 2019; 36:274-282. [PMID: 31025427 PMCID: PMC7167752 DOI: 10.1111/pde.13827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cutaneous hypersensitivity reactions in infants present in a variety of patterns. These skin eruptions can be dramatic, causing alarm in parents and medical personnel. Many of these syndromes have overlapping features, which adds to the confusion and uncertainty regarding diagnosis and management. This review discusses the spectrum of hypersensitivity responses with a focus on their presentation in infants. The clinical findings, pathophysiology, histopathology, management, and complications of these conditions will be reviewed.
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Affiliation(s)
- Kathryn A Arnold
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Jingyun Gao
- Section of Dermatology, Department of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Sarah L Stein
- Section of Dermatology, Department of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
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21
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Abstract
We have explored the rash that appears as target lesions, with the central and dominant diseases belonging to the Stevens-Johnson syndrome/toxic epidermal necrolysis group. After presenting the clinical patterns of an individual target lesion and classifying them into different types of lesions, the contribution has been organized with groups characterized by such specific findings according to the type of lesion: flat or raised, typical or atypical, presence or absence of fever, presence or absence of mucosal ulcerations, presence or absence of arthralgias, and/or internal organ involvement. Other specific features, such as histologic appearance, immunofluorescence findings, and laboratory changes, are considered. We provide clinicians with an algorithmic, systematic, and logical approach to diagnose the condition of the patients who present with targetoid lesions, and enable them to differentiate between those with serious systemic and life-threatening diseases from others with ordinary skin ailments.
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Affiliation(s)
- Ronni Wolf
- The School of Medicine, Hebrew University, Jerusalem, Israel; Hadassah Medical Center, Jerusalem, Israel.
| | - Jennifer L Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lawrence Charles Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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