Serum sickness: Difference between revisions

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==Background==
==Background==
*A type III hypersensitivity reaction
[[File:Serum_sickness.jpeg|thumb|Typical appearance of serum sickness rash]]
**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
*Reactions secondary to the administration of nonprotein drugs (e.g. [[Amoxicillin]], [[cefaclor]], [[cephalexin]] (Keflex), [[trimethoprim-sulfamethoxazole]])
**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


==Diagnosis==
==Clinical Features==
#Primary occurs 6-21 days after exposure
*[[Fever]]
##1-4 days after subsequent exposures to the same antigen
*[[Arthralgia]]
#Fever
*[[Lymphadenopathy]]
#Arthralgia
*Skin eruption (rash)
#Lymphadenopathy
**[[Urticaria]]
#Skin eruption (rash)
**Scarlatiniform [[rash]]
##Urticaria
**Maculopapular or purpuric lesions
##Scarlatiniform rash
**[[Erythema multiforme]]
##Maculopapular or purpuric lesions
##Erythema multiforme
==DDX==
# Erythema Multiforme
# Mononucleosis
# Polymyositis
# Systemic Lupus Erythematosus
# Tick-Borne Diseases, Rocky Mountain Spotted Fever
# Toxic Epidermal Necrolysis


==Treatment==
==Differential Diagnosis==
#D/C antigen
*[[Erythema multiforme]]
#Diphenhydramamine
*[[Mononucleosis]]
#Prednisone
*[[Polymyositis]]
*[[Systemic Lupus Erythematosus]]
*[[Tick borne illnesses]], [[Rocky Mountain Spotted Fever]]
*[[Toxic Epidermal Necrolysis]]
 
{{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>
**Careful investigation of new medications
**[http://emedicine.medscape.com/article/332032-overview#a5 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==
==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==
 


==Prognosis==
==References==
#Symptoms usually last 1-2 weeks before spontaneously subsiding
<references/>
#Long-lasting sequelae generally do not occur
#Fatalities are rare and usually are due to continued administration of the antigen


[[Category:Derm]]
[[Category:Dermatology]]
[[Category:Rheumatology]]

Latest revision as of 18:38, 10 January 2022

Background

Typical appearance of serum sickness rash
  • 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

Differential Diagnosis

Polyarthritis

Algorithm for Polyarticular arthralgia

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

Disposition

  • Admit for:
    • Significant comorbidities (advanced or very young age, immunocompromised)
    • Severe symptoms
    • Hemodynamic instability/hypotension
    • Unclear diagnosis

External Links

See Also

References

  1. ↑ Alissa HM et al. Serum Sickness Workup. Dec 14, 2015. http://emedicine.medscape.com/article/332032-workup#showall
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