serum sickness; serum sickness-like reaction

^[1]^[2]^[3]^[4]^[5]

Etiology

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

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]

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]

↑ Taber's Cyclopedic Medical Dictionary, FA Davis, Philadelphia, 1977
↑ ^2.0 ^2.1 ^2.2 ^2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 19. American College of Physicians, Philadelphia 1998, 2021
↑ ^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
↑ ^5.0 ^5.1 ^5.2 ^5.3 NEJM Knowledge+