Serum sickness: Difference between revisions
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==Background== | ==Background== | ||
*A type III [[Hypersensitivity Reaction|hypersensitivity reaction]] | [[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]]) | |||
*Reactions secondary to the administration of nonprotein drugs | *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== | ==Clinical Features== | ||
* | *[[Fever]] | ||
*[[Arthralgia]] | |||
*[[Lymphadenopathy]] | |||
*Arthralgia | |||
*Lymphadenopathy | |||
*Skin eruption (rash) | *Skin eruption (rash) | ||
**Urticaria | **[[Urticaria]] | ||
**Scarlatiniform rash | **Scarlatiniform [[rash]] | ||
**Maculopapular or purpuric lesions | **Maculopapular or purpuric lesions | ||
**Erythema multiforme | **[[Erythema multiforme]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* [[Erythema multiforme]] | *[[Erythema multiforme]] | ||
* [[Mononucleosis]] | *[[Mononucleosis]] | ||
* [[Polymyositis]] | *[[Polymyositis]] | ||
* [[Systemic Lupus Erythematosus]] | *[[Systemic Lupus Erythematosus]] | ||
* Tick | *[[Tick borne illnesses]], [[Rocky Mountain Spotted Fever]] | ||
* [[Toxic Epidermal Necrolysis]] | *[[Toxic Epidermal Necrolysis]] | ||
{{Differential Diagnosis Polyarthritis}} | {{Differential Diagnosis Polyarthritis}} | ||
== | ==Evaluation== | ||
*Clinical diagnosis in which labs may be suggestive but not required<ref>Alissa HM et al. Serum Sickness Workup. Dec 14, 2015. http://emedicine.medscape.com/article/332032-workup#showall</ref> | *Clinical diagnosis in which labs may be suggestive but not required<ref>Alissa HM et al. Serum Sickness Workup. Dec 14, 2015. http://emedicine.medscape.com/article/332032-workup#showall</ref> | ||
*Mild leukopenia or leukocytosis | **Careful investigation of new medications | ||
**[http://emedicine.medscape.com/article/332032-overview#a5 List] of serum sickness medications | |||
*Mild [[leukopenia]] or [[leukocytosis]] | |||
*ESR elevation | *ESR elevation | ||
*Mild proteinuria | *Mild [[proteinuria]] | ||
*Mild hematuria | *Mild [[hematuria]] | ||
*Mild serum | *Mild serum creatinine elevation | ||
*Decreased C3, C4 | *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]] | *[[Prednisone]] | ||
==Disposition== | ==Disposition== | ||
Admit for: | *Admit for: | ||
*Significant comorbidities (advanced or very young age, immunocompromised) | **Significant comorbidities (advanced or very young age, immunocompromised) | ||
*Severe symptoms | **Severe symptoms | ||
*Hemodynamic instability/hypotension | **Hemodynamic instability/hypotension | ||
*Unclear diagnosis | **Unclear diagnosis | ||
==External Links== | |||
*[http://pemcincinnati.com/blog/briefs-serum-sickness-like-reaction-re-post/ Cincinnati PEM Blog Briefs: Serum Sickness] | |||
==See Also== | |||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Dermatology]] | ||
[[Category:Rheumatology]] | |||
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