SERUM
SICKNESS-LIKE ILLNESS IN CROHN’S DISEASE PATIENTS TREATED WITH ANTIBIOTICS
I.Shafran
M.D.and C.Piromalli; Florida Hospital, Orlando, FL.
Thirty-five patients with Crohn’s disease are being
treated with Rifabutin and Macrolide Antibiotic Therapy (RMAT) for a duration of
six months to one year based upon their overall response to treatment. 37%
(13/35) of these patients developed a serum sickness-like illness during the
first four to six weeks of treatment. The patients experienced flu-like symptoms
such as fever, chills, moderate to severe arthralgia, back pain, anorexia and
fatigue. These symptoms generally lasted for a full week and dissipated over the
following three weeks. With each patient, the majority of symptoms stopped
within the first month of treatment. It was also found that these symptoms
responded well to Cox-2 inhibitors (celecoxib - 200mgm po qd) with no adverse
effects or worsening of colitis noted during treatment. These observations
suggest that the Cox-2 inhibitors may help in controlling the initial
side-effects of RMAT. It is also thought that this serum sickness may be a
Jarisch-Herxheimer reaction in response to the antimicrobial therapy. Further
studies will be needed to determine the exact cause and significance of these
symptoms.
All content copyright ©1999 Dr. Ira Shafran, M.D.