Serum sickness-like reaction associated with meropenem in a 3-year old child

Abstract

Background Serum sickness-like reactions are typically characterized by fever, arthralgia, rash, and other systemic symptoms within two weeks of antigen exposure. The most common inciting agents are non-protein drugs, most notably cefaclor. This report describes a 3-year old boy who developed a serum sickness-like reaction after receiving a course of meropenem. Materials and methods Laboratory investigations supporting a diagnosis of serum sickness-like reaction were performed. Results A 3 year old with a history of prematurity was treated with intravenous meropenem and vancomycin for a ventriculoperitoneal shunt infection and brain abscess. He developed fever, bilateral knee swelling and an erythematous maculopapular rash to his trunk and extremities on day 14 of meropenem and day 27 of vancomycin. During this time, he had elevated creatinine and C reactive protein, as well as eosinophilia and hematuria. Septic workup was negative, as were tests for autoimmunity. He also developed transient coagulopathy and pancytopenia, felt to be adverse effects of the antibiotics. He was eventually treated with 3 days of intravenous methylprednisolone, and his symptoms improved soon after. The total duration of serum sickness-like symptoms was about 2 weeks. Conclusions