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You are seeing a 3-year-old boy with 2 days of fever to a maximum of 102.7 F, an urticarial rash (but no enanthem), and significant arthralgias. The individual urticarial lesions are not transient, but rather present for more than 24 hours. He is not toxic but appears miserable. He was diagnosed with acute otitis media 8 days ago and is on day 8 of a 10-day amoxicillin course.
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July 23, 2023 at 9:44 pm
D) Stop the amoxicillin and give a course of prednisone
The child is exhibiting symptoms of serum-sickness like reaction. SSLRs are more common in children, whereas serum sickness is more common in adults. Antibiotics such as penicillin, amoxicillin, TMP-SMX, and cefaclor are common triggers of SSLR. Serum sickness is caused by exposure to non-human antigens, such as in equine anti-toxins or murine-based immune modulators. Classic findings include fever, urticarial rash with individual lesions lasting > 24 hours (unlike acute urticaria), and arthralgias. Treatment of SSLR includes stopping the offending agent, and for moderately severe symptoms a steroid course.