TABLE 47.3 DRUGS IMPLICATED IN SERUM SICKNESS AND DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) Serum sickness Common causes: Antimicrobials: penicillin, trimethoprim-sulfamethoxazole, cefaclor Uncommon causes: Aspirin, indomethacin Antimicrobials: ciprofloxacin, clarithromycin, itraconazole Antiepileptics: carbamazepine Captopril Bupropion, fluoxetine Heparin Insulin Iron-dextran Barbiturates DRESS Antiepileptics: carbamazepine, lamotrigine, phenytoin Antimicrobials: vancomycin, minocycline, dapsone, sulfamethoxazole Sulfasalazine Allopurinol Neoplastic disease that causes generalized adenopathy may be primary to the lymph node, as in lymphoma or it may be caused by an invasion of the lymph node by extrinsic malignant cells, as in leukemia Hodgkin lymphoma, discussed previously, results most often in cervical or supraclavicular adenopathy In contrast, non-Hodgkin lymphoma presents with relatively rapid development (over weeks) of nontender, diffuse lymphadenopathy accompanied by abdominal pain, vomiting, facial swelling, or wheezing due to compression of surrounding structures in the mediastinum or abdomen Children with acute leukemia often have generalized adenopathy, and nodes are firm or rubbery, nontender, and matted These children usually appear ill, having other systemic signs, including fevers, weight loss, bony pain, bruising, petechiae, and hepatosplenomegaly with anemia and thrombocytopenia Histiocytic disorders, caused by the accumulation and infiltration of macrophages and dendritic cells in affected tissues, are a rare cause of generalized adenopathy LCH and sinus histiocytosis (Rosai–Dorfman disease), discussed previously, cause cervical adenopathy; while hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disease in children less than age that manifests with generalized adenopathy in one-third of patients It presents as a febrile illness with adenopathy, cytopenias, coagulopathy,