Paediatrics MCQ – Boy with fever and rash

An eight year old boy presented to the casualty with high fever, pruritic erythematous rash, joint pain and lymph node enlargement. There is a history of upper respiratory tract infection for which he was on cefaclor – 8 days completed of a 10 day course. The most likely diagnosis is?

A. Serum sickness like illness

B. HSP

C. Type III hypersensitivity

D. Kawasaki disease

Correct answer : A. Serum sickness like illness

Serum sickness like reaction can occur following the use of certain drugs, especially cefaclor in children. It presents with an urticarial / purpuric rash, arthritis, lymphadenopathy and fever. But unlike true serum sickness (a type III hypersensitivity response), it is not caused by circulating immune complexes.