To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case Report
Background: Serum sickness-like reaction (SSLR) is a rare cause of drug eruption. The clinical presentation includes fever, rash, and arthralgia which typically occurs 1-2 weeks after the administration of common antibiotics such as amoxicillin or cefaclor. It is a challenging diagnosis because it...
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University Library System, University of Pittsburgh
2025-06-01
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| Series: | International Journal of Medical Students |
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| Online Access: | http://ijms.info/IJMS/article/view/2743 |
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| author | Christodoulos Chatzigrigoriadis George Eleftherakis Kostis Gyftopoulos Stelios F. Assimakopoulos |
| author_facet | Christodoulos Chatzigrigoriadis George Eleftherakis Kostis Gyftopoulos Stelios F. Assimakopoulos |
| author_sort | Christodoulos Chatzigrigoriadis |
| collection | DOAJ |
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Background: Serum sickness-like reaction (SSLR) is a rare cause of drug eruption. The clinical presentation includes fever, rash, and arthralgia which typically occurs 1-2 weeks after the administration of common antibiotics such as amoxicillin or cefaclor. It is a challenging diagnosis because it mimics sepsis and other exanthematous diseases. Rapid Strep Test (RST) is a useful diagnostic test for detecting Streptococcus pyogenes in patients with pharyngitis and Centor score of 3 or more guiding the administration of antibiotics.
The Case: We report a case of a 63-year-old female patient seen in the emergency department (ED) with high-grade fever, diffuse rash, musculoskeletal pain, and a positive RST without clinical evidence of pharyngitis. The primary care physician ordered the RST before the referral to the ED to investigate the febrile rash without a clear indication, misleading to the diagnosis of streptococcal sepsis. She was eventually diagnosed with SSLR and she was treated with corticosteroids, leading to rapid symptomatic relief.
Conclusion: SSLR is an interesting clinical entity, and its pathogenesis is poorly understood. This case emphasizes that SSLR is a clinical diagnosis of exclusion after ruling out other similar disorders. Physicians should be familiar with this benign condition to avoid unnecessary diagnostic testing such as RST which may misguide diagnosis and treatment. Simple diagnostic tests should be used with caution under certain indications; misuse of RST can cause false-positive results, complicating the management of these cases.
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| format | Article |
| id | doaj-art-ecf2aea38d364b718d2100925634d970 |
| institution | OA Journals |
| issn | 2076-6327 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | University Library System, University of Pittsburgh |
| record_format | Article |
| series | International Journal of Medical Students |
| spelling | doaj-art-ecf2aea38d364b718d2100925634d9702025-08-20T02:37:05ZengUniversity Library System, University of PittsburghInternational Journal of Medical Students2076-63272025-06-01To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case ReportChristodoulos Chatzigrigoriadis0George Eleftherakis 1Kostis Gyftopoulos2Stelios F. Assimakopoulos3School of Medicine, University of Patras, Patras, Greece.Department of Internal Medicine, University Hospital of Patras, Patras, Greece. Department of Anatomy, School of Medicine, University of Patras, Patras, Greece. Department of Internal Medicine and Division of Infectious Diseases, University of Patras Medical School, Patras, Greece. Background: Serum sickness-like reaction (SSLR) is a rare cause of drug eruption. The clinical presentation includes fever, rash, and arthralgia which typically occurs 1-2 weeks after the administration of common antibiotics such as amoxicillin or cefaclor. It is a challenging diagnosis because it mimics sepsis and other exanthematous diseases. Rapid Strep Test (RST) is a useful diagnostic test for detecting Streptococcus pyogenes in patients with pharyngitis and Centor score of 3 or more guiding the administration of antibiotics. The Case: We report a case of a 63-year-old female patient seen in the emergency department (ED) with high-grade fever, diffuse rash, musculoskeletal pain, and a positive RST without clinical evidence of pharyngitis. The primary care physician ordered the RST before the referral to the ED to investigate the febrile rash without a clear indication, misleading to the diagnosis of streptococcal sepsis. She was eventually diagnosed with SSLR and she was treated with corticosteroids, leading to rapid symptomatic relief. Conclusion: SSLR is an interesting clinical entity, and its pathogenesis is poorly understood. This case emphasizes that SSLR is a clinical diagnosis of exclusion after ruling out other similar disorders. Physicians should be familiar with this benign condition to avoid unnecessary diagnostic testing such as RST which may misguide diagnosis and treatment. Simple diagnostic tests should be used with caution under certain indications; misuse of RST can cause false-positive results, complicating the management of these cases. http://ijms.info/IJMS/article/view/2743Serum SicknessExanthemaDrug EruptionAmoxicillinStreptococcus pyogenes |
| spellingShingle | Christodoulos Chatzigrigoriadis George Eleftherakis Kostis Gyftopoulos Stelios F. Assimakopoulos To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case Report International Journal of Medical Students Serum Sickness Exanthema Drug Eruption Amoxicillin Streptococcus pyogenes |
| title | To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case Report |
| title_full | To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case Report |
| title_fullStr | To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case Report |
| title_full_unstemmed | To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case Report |
| title_short | To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case Report |
| title_sort | to test or not to test how a positive rapid strep test may perplex the diagnosis of serum sickness like reaction in a case report |
| topic | Serum Sickness Exanthema Drug Eruption Amoxicillin Streptococcus pyogenes |
| url | http://ijms.info/IJMS/article/view/2743 |
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