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Serum Sickness in El Salvador

Serum Sickness in El Salvador. 12/07 Wal-Mart added Lamisil (terbinafine) to its $4 list lowering in the price of a 3 month course of Rx for toenail fungal disease to $27. Post physical, I started 250 mg daily and had normal LFT’s at three weeks.

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Serum Sickness in El Salvador

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  1. Serum Sickness in El Salvador

  2. 12/07 Wal-Mart added Lamisil (terbinafine) to its $4 list lowering in the price of a 3 month course of Rx for toenail fungal disease to $27. • Post physical, I started 250 mg daily and had normal LFT’s at three weeks.

  3. En route to El Salvador I developed diffuse hives, erythema and swelling of hands and feet with intense pruritis; stopped Lamisil. • Went to grocery store in San Salvador and found chlorpheniramine. Traveled to central El Salvador for project. Benadryl and Ibuprofen for increasing periarthritic pains.

  4. 2 days of increased malaise , chills, fever, intense periarthralgias, hives and edema of hands poorly controlled by antihistamines and Ibuprofen 800mg tid. • Day 4 began prednisone and stopped the other meds. • Gradual improvement over one month

  5. Turbinafine - 1/2 life of 36 hours. Terminal elimination from serum takes 200-400 hours. • 1-10% rate of hives,dermatitis, arthralgia, myalgia • <1% rate of angioedema, drug induced lupus, toxic epidermal necrolysis, liver failure and and Stevens-Johnson syndrome.

  6. Serum sickness; • Rash fever, polyarthritis, poly arthralgias after 2 weeks of exposure to a medicine or foreign protein • Remission one to two weeks post D/C of exposure. • First described with Horse Serum use in 1905.

  7. Type III antigen-antibody complex disease with complement activation. • IgM IgG IgE IgA - time course favors IgM • Resolution when antigen is completely removed from serum - (?nails) • Recurrent exposure causes illness within 36 hours

  8. Serum sickness like illness - not antigen-antibody and mostly urticaria and fever, arthralgias. Ceclor, anti-seizure meds, sulfas, strept and viral infections. • Urticaria-arthralgia syndrome. Drugs act as a hapten and invoke direct antibody response while present without complement activation.

  9. 85% of pts given antithymocyte antibodies for bone marrow failure. • 40-80% of pts given anti venom for snake bite • 1.5% of pts given diphtheria antitoxin have serum sickness. • Remicade 25% if long delay between infusions. 3% if continuous.

  10. DDx - viral - more oral lesions • - hypersensitivity and urticarial vasculitis - vasculitic and low C • - Rheumatic Fever - more joint swelling and other features • DGI and Meningococcemia - pustular lesions • Reactive arthritis - more joint and mucous membrane • E multiforme - palms and soles, target lesions • Stevens-Johnson and toxic epidermal necrolysis - vesicular lesions • Still’s disease - rash • Kawasaki’s - hand and foot swelling; more mucosal

  11. Personal observations on medicines: • Prednisone is short acting; interferes with sleep; more effective than ibuprofen for systemic sx. Visual hallucinations? • Benadryl causes lethargy and spaced feeling.

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