背景:血清病样反应(SSLR)是一种以皮疹为特征的免疫反应,多关节痛,炎症,和发烧。血清病样反应通常归因于抗生素,抗惊厥药,和抗炎药。
方法:一名16岁女性,有膀胱过度活动症和贫血病史,表现为弥漫性荨麻疹,头痛,关节痛,和肿胀三天。她的药物包括口服避孕药,铁,Mirabegron,UQora,和益生菌。体格检查发现弥漫性荨麻疹,她的肌肉骨骼检查显示手腕肿胀和压痛。她接受了儿科医生的评估,并开始了为期7天的强的松疗程,以及抗组胺药.她的CBC,基础代谢小组,肝功能面板,莱姆滴度,尿液分析均在正常范围内。考虑到对药物的超敏反应,所有药物均停用.症状出现九天后,患者由过敏症专科医生进行了评估,证实她的表现与血清病样反应一致。她的症状消失了,她的药物在几个月内依次重新使用。重启UQora,然而,引发了她症状的复发,它被确定为罪魁祸首药物。因此,UQora永久停产,患者仍无症状。
结论:本病例报告描述了首例由UQora(活性成分D-甘露糖)引起的血清病样反应。D-甘露糖是一种单糖,它经常被推广以防止尿路感染。虽然这种情况下的临床特征和时间表是典型的血清病样反应,UQora作为触发器非常不寻常。临床医生应意识到血清病样反应的多种触发因素,以及及时识别和管理以提高患者安全性的重要性。进一步的研究是必要的,以更好地了解D-甘露糖的潜在治疗应用,以及潜在的风险和相互作用。
BACKGROUND: Serum Sickness-Like Reaction (SSLR) is an immune response characterized by rash, polyarthralgias, inflammation, and fever. Serum sickness-like reaction is commonly attributed to antibiotics, anticonvulsants, and anti-inflammatory agents.
METHODS: A 16-year-old female with a history of overactive bladder and anemia presented with a diffuse urticarial rash, headaches, joint pain, and swelling for three days. Her medications included oral contraceptive pills, iron, mirabegron, UQora, and a probiotic. Physical examination revealed a diffuse urticarial rash, and her musculoskeletal exam revealed swelling and tenderness in her wrists. She was evaluated by her pediatrician and started on a 7-day course of prednisone, as well as antihistamines. Her CBC, basic metabolic panel, liver function panel, Lyme titers, and urinalysis were all within normal limits. With concern for hypersensitivity reaction to medication, all medications were discontinued. Nine days after symptom onset, the patient was evaluated by an allergist, who confirmed her presentation was consistent with serum sickness-like reaction. Her symptoms resolved, and her medications were re-introduced sequentially over several months. Restarting UQora, however, triggered a recurrence of her symptoms, and it was identified as the culprit medication. Consequently, UQora was permanently discontinued, and the patient has remained symptom-free.
CONCLUSIONS: This case report describes the first documented case of serum sickness-like reaction caused by UQora (active ingredient D-mannose). D-mannose is a monosaccharide, and it is frequently promoted to prevent urinary tract infections. While the clinical features and timeline in this case were typical of serum sickness-like reaction, UQora as the trigger was highly unusual. Clinicians should be aware of the diverse triggers of serum sickness-like reaction and the importance of prompt identification and management to enhance patient safety. Further research is necessary to better understand the potential therapeutic applications of D-mannose, as well as the potential risks and interactions.