Serum Sickness - UNC School of Medicine
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Transcript Serum Sickness - UNC School of Medicine
Serum Sickness
Jill Tichy, M.D. PGY III
Serum Sickness
What is it?
Immunization of host (human) by
heterologous (non-human) serum proteins
caused by formation of immune
complexes
A diagnosis made clinically and one of
exclusion
Definition continued…
Cardinal symptoms include rash, fever,
polyarthralgias or polyarthritis
Malaise
Occurs one to two weeks after first
exposure to responsible agent
Resolves within a few weeks of
discontinuing the drug
Type III or Immune Complex
Mediated Hypersensitivity
Antigens combine with host
immunoglobulins specific to those
antigens
Resultant immune complexes are in excess
of phagocyte system
Deposit in tissues and trigger the
inflammatory response
Blame the heterologous proteins
Equine or Rabbit Antithymocyte Globulin (ATG)
Rituximab
Inflimixab
Venom Anti-toxins
Rabies Vaccine
Streptokinase
Penicillin
Cefaclor
Amoxicillin
Bactrim
Supportive Physical Exam Findings
Pruritic Rash sparing the mucous
membranes
Rash can be serpiginous and macular
which starts at the trunk and spreads
distally
*Skin changes at the junction of the
lateral aspect of palms and soles
Supportive Physical Exam Findings
Supportive Physical Exam Findings
Joints commonly involved are: MCP, knees,
wrists, ankles and shoulders
Spine and TMJ involvement is also
reported
Joint pain typically occurs after rash has
started
Myalgias also seen
Trismus
Supportive Laboratory Data
Neutropenia with reactive lymphocytes
Mild Thrombocytopenia
Eosinophilia
Elevated CRP and ESR
Proteinuria (50% of patients)
Elevations in creatinine
Supportive Laboratory Data
Dermatopathology
Histology varies
Typical is mild peri-vascular infiltrates with
lymphocytes and histiocytes without
vessel necrosis
Differential Diagnosis
Acute Rheumatic Fever
Disseminated gonococcemia and meningococcemia
Reactive Arthritis (Reiter’s Syndrome)
Rickettsial Diseases
Disseminated EBV/CMV
Stevens-Johnson Syndrome
Still’s Disease
Kawasaki’s Disease
Viral Exanthems
Treatment
Stop offending agent
Mild symptoms self-limiting
Anti-histamines; NSAIDs
Severe symptoms (fever > 38.5; extensive
rash, severe arthritis) give steroids
Avoid responsible drug in the future
Not clear if similar drugs should be
avoided
References
Lawley, TJ, Bielory, L, Gascon, P, et al. A prospective
clinical and immunologic analysis of patients with serum
sickness. N Engl J Med 1984; 311:1407
Bielory, L, Yancey, KB, Young, NS, et al. Cutaneous
Manifestations of serum sickness in patients receiving
antithymocyte globulin. J AM Acad Dermatol 1985;
13:411
Snow, M, Cannella, A, Stevens, RB, Presumptive Serum
Sickness as a Complication of Rabbit-Derived
Antithymocyte Globulin Immunosuppression
Harrison’s Textbook of Internal Medicine
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