A two-year-old male child was given 8 days of cefaclor of 10 days course. The child developed low grade fever, malaise, lymphadenopathy, irritability, generalized erythematous rash which are mildly pruritic. Most probable diagnosis is
Correct Answer: Type 3 hypersensitivity
Description: Type 3 hypersensitivity Immunologically mediated adverse drug been reactions have AND classified according to the GELL COOMBS CLASSIFICATION. The 4 types are: Immediate hypersensitivity - It occurs when the drug or drug metabolite interacts with preformed drug specific IgE antibodies that are bound to the surfaces of tissue mast cells and/or circulating basophils. Clinically manifests with uicaria, bronchospasm and anaphylaxis Cytotoxic reactions - Involve IgG or IgM antibodies that recognize drug antigen on cell membrane. In the presence of serum complement, the antibody coated cell is either cleared by the monocytes or macrophage system or is destroyed. Examples include drug induced hemolytic anemia or thrombocytopenia. Immune complex reactions (Type /I hypersensitivity) - It is caused by soluble complexes of drug or metabolite in slight antigen excess with IgG or IgM antibodies. The immune complex is deposited in blood vessel walls and causes injury by activating the complement cascade as seen in serum sickness. Clinical manifestations include fever, uicaria, rash, lymphadenopathy, and ahralgias. Symptoms typically appear 1-3 weeks after the last dose of an offending drug and subside when the drug and/or its metabolites are cleared from the body. Delayed hypersensitivity - These are mediated by drug specific T lymphocytes. Commonly implicated drugs include neomycin and local anesthetics in topical formulations. "Serum sickness like reactions in which immune complexes have not been documented, which occur most commonly with cefaclor, may result from an inherited propensity for hepatic biotransformation of drugs into toxic or immunogenic metabolites."
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