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
DOI:
https://doi.org/10.5195/ijms.2025.2743Keywords:
Serum Sickness, Exanthema, Drug Eruption, Amoxicillin, Streptococcus pyogenesAbstract
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.
Metrics
References
Balakirski G, Merk HF. Cutaneous allergic drug reactions: update on pathophysiology, diagnostic procedures and differential diagnosic. Cutan Ocul Toxicol. 2017;36(4):307-16.
Del Pozzo-Magaña 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):428-35.
Knowles S, Shapiro L, Shear NH. Serious dermatologic reactions in children. Curr Opin Pediatr. 1997;9(4):388-95.
Levine LR. Quantitative comparison of adverse reactions to cefaclor vs. amoxicillin in a surveillance study. Pediatr Infect Dis. 1985;4(4):358-61.
Isaacs D. Serum sickness-like reaction to cefaclor. J Paediatr Child Health. 2001;37(3):298-9.
Mohsenzadeh A, Movahedi M, Saatchi M, Parvaneh N, Shariat M, Aghamohammadi A, et al. Serum sickness-like reactions in Iranian children: a registry-based study in a referral center. Allergol Immunopathol (Madr). 2020;48(5):424-9.
Stricker BH, Tijssen JG. Serum sickness-like reactions to cefaclor. J Clin Epidemiol. 1992;45(10):1177-84.
Wolf R, Orion E, Marcos B, Matz H. Life-threatening acute adverse cutaneous drug reactions. Clin Dermatol. 2005;23(2):171-81.
Arnold KA, Gao J, Stein SL. A review of cutaneous hypersensitivity reactions in infants: From common to concerning. Pediatr Dermatol. 2019;36(3):274-82.
ESCMID Sore Throat Guideline Group; Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012;18Suppl 1:1-28.
Hoffmann S. The throat carrier rate of group A and other beta hemolytic streptococci among patients in general practice. Acta Pathol Microbiol Immunol Scand B. 1985;93(5):347-51.
Vial T, Pont J, Pham E, Rabilloud M, Descotes J. Cefaclor-associated serum sickness-like disease: eight cases and review of the literature. Ann Pharmacother. 1992;26(7-8):910-4.
Alotaibi A, Binsaqr MA, Mutlaq MR, Khojah AA, Khojah SA, Mohamed HA. Atypical Presentation of Scarlet Fever. Cureus. 2022;14(12):e33142.
Batta S, Pederson H, Brust KB, Fiala KH. Acute rheumatic fever and erythema marginatum in an adult patient. Proc (Bayl Univ Med Cent). 2022;35(4):550-1.
Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still's disease. J Autoimmun. 2018;93:24-36.
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Christodoulos Chatzigrigoriadis, George Eleftherakis , Kostis Gyftopoulos, Stelios F. Assimakopoulos
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org
