Serum sickness: Difference between revisions
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==Background== | ==Background== | ||
*A type III [[Hypersensitivity Reaction|hypersensitivity reaction]] | *A type III [[Hypersensitivity Reaction|hypersensitivity reaction]] | ||
**Secondary to injection of anitoxins (e.g. tetanus, rabies) | **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 | ||
**Amoxicillin, cefaclor, [[cephalexin]] (Keflex), trimethoprim-sulfamethoxazole | **[[Amoxicillin]], [[cefaclor]], [[cephalexin]] (Keflex), [[trimethoprim-sulfamethoxazole]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Primary occurs 6-21 days after exposure | *Primary occurs 6-21 days after exposure | ||
**1-4 days after subsequent exposures to the same antigen | **1-4 days after subsequent exposures to the same antigen | ||
*Fever | *[[Fever]] | ||
*Arthralgia | *Arthralgia | ||
*Lymphadenopathy | *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== | ||
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*ESR elevation | *ESR elevation | ||
*Mild proteinuria | *Mild proteinuria | ||
*Mild hematuria | *Mild [[hematuria]] | ||
*Mild serum Cr elevation | *Mild serum Cr elevation | ||
*Decreased C3, C4 | *Decreased C3, C4 | ||
==Treatment== | ==Treatment== | ||
* | *Discontinue antigen | ||
*Antipyretics | *Antipyretics | ||
*[[Diphenhydramamine]] | *[[Diphenhydramamine]] | ||
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*Fatalities are rare and usually are due to continued administration of the antigen | *Fatalities are rare and usually are due to continued administration of the antigen | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Derm]] | [[Category:Derm]] | ||
Revision as of 13:14, 21 January 2016
Background
- A type III hypersensitivity reaction
- Reactions secondary to the administration of nonprotein drugs
- Amoxicillin, cefaclor, cephalexin (Keflex), trimethoprim-sulfamethoxazole
Clinical Features
- Primary occurs 6-21 days after exposure
- 1-4 days after subsequent exposures to the same antigen
- 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 Diseases, 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
Diagnosis
- Clinical diagnosis in which labs may be suggestive but not required[1]
- Careful investigation of new medications
- List of serum sickness medications extensive
- Mild leukopenia or leukocytosis
- ESR elevation
- Mild proteinuria
- Mild hematuria
- Mild serum Cr elevation
- Decreased C3, C4
Treatment
- Discontinue antigen
- Antipyretics
- Diphenhydramamine
- Prednisone
Disposition
Admit for:
- Significant comorbidities (advanced or very young age, immunocompromised)
- Severe symptoms
- Hemodynamic instability/hypotension
- Unclear diagnosis
Prognosis
- 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
References
- ↑ Alissa HM et al. Serum Sickness Workup. Dec 14, 2015. http://emedicine.medscape.com/article/332032-workup#showall