Micro & Immunology · patient case question
What is the most appropriate management of this second presentation?
Patient case: Rash After Local Anesthetic in a Child
Patient: 10-year-old male
Chief Complaint: Restorative treatment on two mandibular molars.
Background: Healthy, no known allergies, no previous dental treatment requiring anesthesia. Immunizations current.
Medications: None
Vital Signs: Baseline: BP 100/62 mmHg · HR 86 bpm · RR 18 · T 98.4°F
Findings: Twenty minutes after administration of 2% lidocaine with 1:100,000 epinephrine, he develops a generalized raised urticarial rash over the trunk and arms, accompanied by nausea, one episode of vomiting, and loose stools. Mild expiratory wheeze is audible. Airway is patent, phonation is normal, and blood pressure remains stable at 98/60 mmHg.
Show answer and explanation
Correct answer: A. Systemic corticosteroids with supportive care and withdrawal of the trigger
- A. Correct. Management centers on identifying and removing the trigger, systemic corticosteroids for significant cases, and supportive care — hydration, analgesia, topical anesthetic rinses, and a soft diet. Where herpes simplex is the recurrent precipitant, prophylactic antiviral therapy prevents further episodes.
- B. Incorrect. Debridement would worsen an already compromised epithelial surface and has no place in management.
- C. Incorrect. This is an immune-mediated process, not a fungal infection. Antifungals have no role.
- D. Incorrect. Antibiotics are not indicated and are frequently the trigger. Sulfonamides, penicillins, and anticonvulsants are among the commonest drug causes.
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