Serum sickness in el salvador
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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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Serum sickness in el salvador

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.


Serum sickness in el salvador

  • 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.


Serum sickness in el salvador

  • 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


Serum sickness in el salvador

  • 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.


Serum sickness in el salvador

  • 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.


Serum sickness in el salvador

  • 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


Serum sickness in el salvador

  • 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.


Serum sickness in el salvador

  • 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.


Serum sickness in el salvador

  • 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


Serum sickness in el salvador

  • 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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