Serum sickness: Difference between revisions
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==Background== | ==Background== | ||
[[File:Serum_sickness.jpeg|thumb|Typical appearance of serum sickness rash]] | |||
*A type III [[Hypersensitivity Reaction|hypersensitivity reaction]] (secondary to injection of anitoxins e.g. [[tetanus]], [[rabies]]) | *A type III [[Hypersensitivity Reaction|hypersensitivity reaction]] (secondary to injection of anitoxins e.g. [[tetanus]], [[rabies]]) | ||
*Reactions secondary to the administration of nonprotein drugs (e.g. [[Amoxicillin]], [[cefaclor]], [[cephalexin]] (Keflex), [[trimethoprim-sulfamethoxazole]]) | *Reactions secondary to the administration of nonprotein drugs (e.g. [[Amoxicillin]], [[cefaclor]], [[cephalexin]] (Keflex), [[trimethoprim-sulfamethoxazole]]) | ||
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==Clinical Features== | ==Clinical Features== | ||
*[[Fever]] | *[[Fever]] | ||
*Arthralgia | *[[Arthralgia]] | ||
*Lymphadenopathy | *[[Lymphadenopathy]] | ||
*Skin eruption (rash) | *Skin eruption (rash) | ||
**[[Urticaria]] | **[[Urticaria]] | ||
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**Maculopapular or purpuric lesions | **Maculopapular or purpuric lesions | ||
**[[Erythema multiforme]] | **[[Erythema multiforme]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Erythema multiforme]] | *[[Erythema multiforme]] | ||
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*[[Polymyositis]] | *[[Polymyositis]] | ||
*[[Systemic Lupus Erythematosus]] | *[[Systemic Lupus Erythematosus]] | ||
*Tick | *[[Tick borne illnesses]], [[Rocky Mountain Spotted Fever]] | ||
*[[Toxic Epidermal Necrolysis]] | *[[Toxic Epidermal Necrolysis]] | ||
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**Careful investigation of new medications | **Careful investigation of new medications | ||
**[http://emedicine.medscape.com/article/332032-overview#a5 List] of serum sickness medications | **[http://emedicine.medscape.com/article/332032-overview#a5 List] of serum sickness medications | ||
*Mild leukopenia or leukocytosis | *Mild [[leukopenia]] or [[leukocytosis]] | ||
*ESR elevation | *ESR elevation | ||
*Mild proteinuria | *Mild [[proteinuria]] | ||
*Mild [[hematuria]] | *Mild [[hematuria]] | ||
*Mild serum creatinine elevation | *Mild serum creatinine elevation | ||
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*Other labs to obtain: | *Other labs to obtain: | ||
**CH50 | **CH50 | ||
**LFTs | **[[LFTs]] | ||
**Urine electrolytes (Na, K, Cr, eosinophils) | **Urine electrolytes (Na, K, Cr, eosinophils) | ||
**ESR and CRP | **ESR and CRP | ||
** | **[[Viral hepatitis]] panel, HIV, RPR/VDRL | ||
==Management== | ==Management== | ||
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==External Links== | ==External Links== | ||
*[http://pemcincinnati.com/blog/briefs-serum-sickness-like-reaction-re-post/ Cincinnati PEM Blog Briefs: Serum Sickness] | |||
==See Also== | ==See Also== | ||
Latest revision as of 18:38, 10 January 2022
Background
- A type III hypersensitivity reaction (secondary to injection of anitoxins e.g. tetanus, rabies)
- Reactions secondary to the administration of nonprotein drugs (e.g. Amoxicillin, cefaclor, cephalexin (Keflex), trimethoprim-sulfamethoxazole)
- Primary occurs 6-21 days after initial exposure
- 1-4 days after subsequent exposures to the same antigen
- Symptoms usually last 1-2 weeks before spontaneously subsiding
- Long-lasting sequelae generally do not occur
- Fatalities are rare and usually are due to continued administration of the antigen
Clinical Features
- Fever
- Arthralgia
- Lymphadenopathy
- Skin eruption (rash)
- Urticaria
- Scarlatiniform rash
- Maculopapular or purpuric lesions
- Erythema multiforme
Differential Diagnosis
- Erythema multiforme
- Mononucleosis
- Polymyositis
- Systemic Lupus Erythematosus
- Tick borne illnesses, Rocky Mountain Spotted Fever
- Toxic Epidermal Necrolysis
Polyarthritis
- Fibromyalgia
- Juvenile idiopathic arthritis
- Lyme disease
- Osteoarthritis
- Psoriatic arthritis
- Reactive poststreptococcal arthritis
- Rheumatoid arthritis
- Rheumatic fever
- Serum sickness
- Systemic lupus erythematosus
- Serum sickness–like reactions
- Viral arthritis
Evaluation
- Clinical diagnosis in which labs may be suggestive but not required[1]
- Careful investigation of new medications
- List of serum sickness medications
- Mild leukopenia or leukocytosis
- ESR elevation
- Mild proteinuria
- Mild hematuria
- Mild serum creatinine elevation
- Decreased C3, C4
- Other labs to obtain:
- CH50
- LFTs
- Urine electrolytes (Na, K, Cr, eosinophils)
- ESR and CRP
- Viral hepatitis panel, HIV, RPR/VDRL
Management
- Discontinue antigen
- Antipyretics
- Diphenhydramine
- Prednisone
Disposition
- Admit for:
- Significant comorbidities (advanced or very young age, immunocompromised)
- Severe symptoms
- Hemodynamic instability/hypotension
- Unclear diagnosis
External Links
See Also
References
- ↑ Alissa HM et al. Serum Sickness Workup. Dec 14, 2015. http://emedicine.medscape.com/article/332032-workup#showall