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.
Tatum
A J
AJ
Department of Medicine and the Ernest S. Bazley Asthma and Allergic Diseases Center of Northwestern Memorial Hospital and Northwestern University Medical School, Chicago, Illinois, USA.
Ditto
A M
AM
Patterson
R
R
D000284:Administration, Oral; D000328:Adult; D000818:Animals; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007136:Immunoglobulins / Q000096:biosynthesis; D010406:Penicillins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011817:Rabbits; D012710:Serum Albumin, Bovine / Q000276:immunology; D012713:Serum Sickness / Q000139:chemically induced / Q000175:diagnosis* / Q000276:immunology
D005938:Glucocorticoids; D007136:Immunoglobulins; D010406:Penicillins; D012710:Serum Albumin, Bovine; D011241:Prednisone