serum sickness in el salvador
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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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slide2
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.
slide3
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.
slide6
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
slide9
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.
slide11
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.
slide12
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
slide16
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.
slide17
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.
slide18
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
slide23
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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