Serum sickness-like reaction associated with cefazolin

A 23 year old man with no significant past medical history was admitted to undergo a laparoscopic donor nephrectomy as part of a living-related renal transplant. One gram of intravenous cefazolin was administered perioperatively. The surgery was completed without complication and the remainder of his hospital course was uneventful. Ten days following discharge the patient developed fevers, painful and swollen joints, and a cutaneous eruption overlying his trunk and extremities. There was no evidence of systemic vasculitis. These clinical findings were most consistent with a serum sickness-like reaction. A brief course of corticosteroids and antihistaminergic therapy was initiated, and complete resolution of the patient's symptoms followed. The Naranjo probability scale indicated that this adverse drug event was probable.Serum sickness-like reaction may be associated with cefazolin therapy.Serum sickness-like reactions (SSLR), although rare in clinical practice, have been documented to occur following the administration of many medications. While the pathophysiology which produces SSLR are not clear, they are constituted by an array of clinical findings including fever, cutaneous eruptions and arthralgias/arthritis. Literature reports have implicated several antibiotics including ciprofloxacin [1,2], minocycline[3], cefprozil[4], and cefaclor [5-7]. Herein, we report a probable case of SSLR following a single dose of cefazolin.The patient, a 23 year old male with no significant past medical history, underwent left laparoscopic donor nephrectomy as part of a living-related renal transplant. On the day of surgery he was administered one gram of intravenous cefazolin which served as routine perioperative prophylaxis. Anesthesia was achieved with inhaled desflurane, along with fentanyl, propofol, and midazolam. Cisatracurium was employed for neuromuscular blockade. Post operatively, he received morphine sulfate, ketorolac, and ondansetron. His recovery was uneventful, an