A patient is evaluated for a several-day history of fever, malaise, urticaria, arthralgias, lymphadenopathy, and a peculiar erythema along the sides of his palms and soles. He has been started on several new medications in the last few weeks. What is the most likely diagnosis? The patient most likely has a serum sickness–like drug eruption caused by immune complexes and complement activation. The diagnostic cutaneous finding is the characteristic erythema on the sides of the palms and soles, a finding seen in 75% of cases of serum sickness–like drug eruptions. Other typical findings include fever and malaise (100%), urticaria (90%), arthralgias (50% to 67%), and lymphadenopathy (13%). Glomerulonephritis is common in serum sickness reactions in animals but uncommon in humans. Reactions occur 7 to 21 days after the drug is given but may occur with the first administration of the drug. Commonly implicated drugs include beta-lactam antibiotics, sulfonamides, thiouracil, cholecystographic dyes, and hydantoin. |
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