serum sickness; serum sickness-like reaction
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Etiology
- foreign serum, non-human serum proteins
- rabbit anti-thymocyte globulin
- drugs (serum sickness-like reaction, amoxicillin, Augmentin)[3]
- chimeric pharmaceutical monoclonal antibodies containing murine light & heavy chain variable regions & human constant region[2] -infliximab, rituximab
Pathology
- systemic immune complex formation after administration of drug or foreign serum to patient (type 3 hypersensitivity)
- mediated mainly by IgG
- vascular, cutaneous, cardiac, renal & joint immune complex deposition may result
Clinical manifestations
- symptoms may occur from days to 3 weeks after administration of offending agent
- generally occurs within 7-14 days after administration of offending agent
- fever
- lymphadenopathy
- splenomegaly (unlikely with serum sickness-like reactions)
- pruritic rash, urticaria
- described as 'serpinginous maculopapular eruptions' (NEJM)[5]
- arthralgias
- myalgias
- serum sickness-like reactions less severe than serum sickness
* typically 1-2 weeks for amoxicillin & Augmentin[2]
Complications
- glomerulonephritis
- hepatitis (uncommon)
Differential diagnosis
- type B drug reaction
- anthralgia uncommon
- unlikely to occur with 1-2 weeks of drug administration[2]
- delayed type hypersensitivity reaction: no fever or arthralgia[5]
- pyrogenic reaction to antivenom
- due to pyrogen contamination in manufacturing
- occur within 1st hour of antivenom administration[5]
Management
- symptomatic
- glucocorticoids
More general terms
References
- ↑ Taber's Cyclopedic Medical Dictionary, FA Davis, Philadelphia, 1977
- ↑ Jump up to: 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 19. American College of Physicians, Philadelphia 1998, 2021
- ↑ Jump up to: 3.0 3.1 NEJM Knowledge+ Question of the Week. Jan 31, 2017 http://knowledgeplus.nejm.org/question-of-week/1250/
Lin B, Strehlow M. Images in emergency medicine. Serum sickness-like reaction to amoxicillin. Ann Emerg Med. 2007 Sep;50(3):350, 359. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17709052 - ↑ McNamara K, Hughes OB, Strowd LC. Cutaneous drug eruptions including serum sickness-like reaction, symmetrical drug-related intertriginous and flexural exanthema, and drug-induced lupus. Clin Dermatol. 2020 Nov - Dec;38:641-647. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33341198
- ↑ Jump up to: 5.0 5.1 5.2 5.3 NEJM Knowledge+