{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:41:04Z","timestamp":1787020864424,"version":"build-2736575974"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Allergy Asthma Clin Immunol"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Serum-sickness like reactions (SSLRs) to amoxicillin have been documented in the medical literature. Beta-lactams are important and commonly used medications especially in the pediatric population. Often, SSLRs present within days of and during first exposure\/ingestion to the offending agent. We described a unique case of a 4-year-old boy who presented with symptoms of amoxicillin SSLR following his second course of amoxicillin with only 2 months and 10 days between his second and first course.<\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n \n A 4-year-old boy presented to hospital with a pruritic rash on day 7 of a 10-day course of amoxicillin for otitis media accompanied by fever (38.7 degrees Celsius). On day 7 of his second course of amoxicillin, which was separated from his first course by only 2 months and 10 days, his mother noticed erythematous, raised, pruritic lesions with central clearing on his sternum. He presented to the ED with emesis, progression of the rash to his torso, back, legs, and face, hypotension, angioedema, and joint pain. His bloodwork demonstrated a leukocytosis of 18.6\u2009\u00d7\u200910\n 9<\/jats:sup>\n g\/L with neutrophilic predominance and thrombocytosis with a platelet count of 653\u2009\u00d7\u200910\n 9<\/jats:sup>\n g\/L. He was treated with 5\u00a0mg oral cetirizine daily and 1\u00a0mg\/kg oral prednisone which improved his rash and angioedema. He was managed with up to 4 times the usual dose of cetirizine. He was assessed in our outpatient clinic as an outpatient and penicillin skin testing was unremarkable. A diagnosis of a probable SSLR to amoxicillin was made.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n We report an unusual presentation of SSLR following re-exposure to amoxicillin. Our case highlights that patients with previous asymptomatic exposure to amoxicillin can develop SSLR with repeat exposure. Although it is not uncommon for children to develop amoxicillin SSLRs after previous exposure to the drug, this case is unique because of its short time course of 2 months and 10 days months between drug courses. Penicillins are commonly used in the pediatric population. Therefore, it is important to correctly characterize adverse drug reactions to broaden our understanding of SSLRs, prevent unnecessary avoidance of the triggering agent, and improve patient management.<\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s13223-024-00887-7","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T12:01:50Z","timestamp":1711972910000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A case of pediatric serum sickness like reaction (SSLR) after a 2-month re-exposure to amoxicillin"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8325-9568","authenticated-orcid":false,"given":"Devyani","family":"Bakshi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxin","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Waserman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,1]]},"reference":[{"key":"887_CR1","first-page":"7608","volume":"21","author":"J Patterson-Fortin","year":"2016","unstructured":"Patterson-Fortin J, Harris CM, Niranjan-Azadi A, Melia M. Serum sickness-like reaction after the treatment of cellulitis with amoxicillin\/clavulanate. BMJ Case Rep. 2016;21:7608.","journal-title":"BMJ Case Rep"},{"issue":"7","key":"887_CR2","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1093\/pch\/pxab003","volume":"26","author":"BR Del Pozzo-Maga\u00f1a","year":"2021","unstructured":"Del Pozzo-Maga\u00f1a BR, Abuzgaia A, Murray B, Rieder MJ, Lazo-Langner A. Paediatric serum sickness-like reaction: a 10-year retrospective cohort study. Paediatr Child Health. 2021;26(7):428\u201335.","journal-title":"Paediatr Child Health"},{"issue":"997","key":"887_CR3","first-page":"123","volume":"108","author":"J Martin","year":"1995","unstructured":"Martin J, Abbott G. Serum sickness like illness and antimicrobials in children. N Z Med J. 1995;108(997):123\u20134.","journal-title":"N Z Med J"},{"issue":"3","key":"887_CR4","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/S1081-1206(10)63308-X","volume":"86","author":"AJ Tatum","year":"2001","unstructured":"Tatum AJ, Ditto AM, Patterson R. Severe serum sickness-like reaction to oral penicillin drugs: three case reports. Ann Allergy Asthma Immunol. 2001;86(3):330\u20134.","journal-title":"Ann Allergy Asthma Immunol"},{"issue":"13","key":"887_CR5","first-page":"9","volume":"7","author":"O Nnomadim","year":"2021","unstructured":"Nnomadim O, Speck H, Vidaurri D. Time after Time: a second look at Evolving Rash with multiple exposures to Amoxicillin. Cureus. 2021;7(13):9.","journal-title":"Cureus"},{"issue":"11","key":"887_CR6","doi-asserted-by":"publisher","first-page":"2951","DOI":"10.1016\/j.jaip.2022.07.002","volume":"10","author":"KM Guarnieri","year":"2022","unstructured":"Guarnieri KM, Xie SS, Courter JD, Liu C, Ruddy RM, Risma KA. Distinct characteristics and chronology of Amoxicillin-Associated reactions in Pediatric Acute Care settings. J Allergy Clin Immunol Pract. 2022;10(11):2951\u2013e29573.","journal-title":"J Allergy Clin Immunol Pract"},{"key":"887_CR7","doi-asserted-by":"crossref","unstructured":"Del Pozzo-Maga\u00f1a BR, Lazo-Langner A. Serum sickness-like reaction in children: review of the literature. EMJ Dermatology. 2019;106\u201311.","DOI":"10.33590\/emjdermatol\/10314478"},{"issue":"2","key":"887_CR8","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1016\/j.jaip.2020.08.047","volume":"9","author":"L Delli Colli","year":"2021","unstructured":"Delli Colli L, Gabrielli S, Abrams EM, O\u2019Keefe A, Protudjer JLP, Lavine E, et al. Differentiating between \u03b2-Lactam-Induced serum sickness\u2013like reactions and viral Exanthem in Children using a graded oral challenge. J Allergy Clin Immunol Pract. 2021;9(2):916\u201321.","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"5","key":"887_CR9","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1016\/S0022-3476(06)80187-3","volume":"125","author":"GL Kearns","year":"1994","unstructured":"Kearns GL, Wheeler JG, Childress SH, Letzig LG. Serum sickness\u2013like reactions to cefaclor: role of hepatic metabolism and individual susceptibility. J Pediatr. 1994;125(5):805\u201311.","journal-title":"J Pediatr"}],"container-title":["Allergy, Asthma & Clinical Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-024-00887-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13223-024-00887-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-024-00887-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T12:04:12Z","timestamp":1711973052000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacijournal.biomedcentral.com\/articles\/10.1186\/s13223-024-00887-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,1]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["887"],"URL":"https:\/\/doi.org\/10.1186\/s13223-024-00887-7","relation":{},"ISSN":["1710-1492"],"issn-type":[{"value":"1710-1492","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,1]]},"assertion":[{"value":"25 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent from the patient\u2019s mother was sought for completion of this case report, written consent obtained.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"29"}}