Pediatric emergency medicine trisk 0933 0933

TABLE 47.3
DRUGS IMPLICATED IN SERUM SICKNESS AND DRUG REACTION WITH
EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS)
Serum sickness
Common causes:
Antimicrobials: penicillin, trimethoprim-sulfamethoxazole, cefaclor
Uncommon causes:
Aspirin, indomethacin
Antimicrobials: ciprofloxacin, clarithromycin, itraconazole
Antiepileptics: carbamazepine
Captopril
Bupropion, fluoxetine
Heparin
Insulin
Iron-dextran
Barbiturates
DRESS
Antiepileptics: carbamazepine, lamotrigine, phenytoin
Antimicrobials: vancomycin, minocycline, dapsone, sulfamethoxazole
Sulfasalazine
Allopurinol
Neoplastic disease that causes generalized adenopathy may be primary to the lymph
node, as in lymphoma or it may be caused by an invasion of the lymph node by extrinsic
malignant cells, as in leukemia. Hodgkin lymphoma, discussed previously, results most
often in cervical or supraclavicular adenopathy. In contrast, non-Hodgkin lymphoma
presents with relatively rapid development (over weeks) of nontender, diffuse
lymphadenopathy accompanied by abdominal pain, vomiting, facial swelling, or
wheezing due to compression of surrounding structures in the mediastinum or abdomen.
Children with acute leukemia often have generalized adenopathy, and nodes are firm or
rubbery, nontender, and matted. These children usually appear ill, having other systemic
signs, including fevers, weight loss, bony pain, bruising, petechiae, and

hepatosplenomegaly with anemia and thrombocytopenia.
Histiocytic disorders, caused by the accumulation and infiltration of macrophages and
dendritic cells in affected tissues, are a rare cause of generalized adenopathy. LCH and
sinus histiocytosis (Rosai–Dorfman disease), discussed previously, cause cervical
adenopathy; while hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal
disease in children less than age 4 that manifests with generalized adenopathy in one-third
of patients. It presents as a febrile illness with adenopathy, cytopenias, coagulopathy,