Mechanism: The precise mechanisms are uncertain. Release of endotoxin has been implicated, as has a massive cytokine release. Infectious lesions may show the sudden onset of intense inflammation which can cause problems if the lesion is in a key location.
Trigger: initiation of antibiotic therapy
Onset: within a few hours
Clinical findings:
(1) fever
(2) rigors
(3) fall in the systolic blood pressure
(4) appears seriously ill
(5) flushing secondary to vasodilation
(6) skin rash
(7) neurological symptoms that may include headache, cranial nerve palsy, seizures, and aseptic meningitis)
(8) visual impairment
(9) laryngeal edema
(10) adult respiratory distress syndrome (ARDS)
(11) sudden death
Laboratory findings:
(1) leukopenia or leukocytosis
(2) elevated serum levels of TNF-alpha, IL-6 and IL-8
The reaction is transient and is typically not seen with subsequent antibiotic doses.
Differential diagnosis:
(1) sepsis
(2) drug allergy
