1 / 13

Serum Sickness

Serum Sickness. Jill Tichy, M.D. PGY III. Serum Sickness What is it?. Immunization of host (human) by heterologous (non-human) serum proteins caused by formation of immune complexes A diagnosis made clinically and one of exclusion. Definition continued….

rene
Download Presentation

Serum Sickness

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Serum Sickness Jill Tichy, M.D. PGY III

  2. Serum SicknessWhat is it? • Immunization of host (human) by heterologous (non-human) serum proteins caused by formation of immune complexes • A diagnosis made clinically and one of exclusion

  3. Definition continued… • Cardinal symptoms include rash, fever, polyarthralgias or polyarthritis • Malaise • Occurs one to two weeks after first exposure to responsible agent • Resolves within a few weeks of discontinuing the drug

  4. Type III or Immune Complex Mediated Hypersensitivity • Antigens combine with host immunoglobulins specific to those antigens • Resultant immune complexes are in excess of phagocyte system • Deposit in tissues and trigger the inflammatory response

  5. Blame the heterologous proteins • Equine or Rabbit Antithymocyte Globulin (ATG) • Rituximab • Inflimixab • Venom Anti-toxins • Rabies Vaccine • Streptokinase • Penicillin • Cefaclor • Amoxicillin • Bactrim

  6. Supportive Physical Exam Findings • Pruritic Rash sparing the mucous membranes • Rash can be serpiginous and macular which starts at the trunk and spreads distally • *Skin changes at the junction of the lateral aspect of palms and soles

  7. Supportive Physical Exam Findings

  8. Supportive Physical Exam Findings • Joints commonly involved are: MCP, knees, wrists, ankles and shoulders • Spine and TMJ involvement is also reported • Joint pain typically occurs after rash has started • Myalgias also seen • Trismus

  9. Supportive Laboratory Data • Neutropenia with reactive lymphocytes • Mild Thrombocytopenia • Eosinophilia • Elevated CRP and ESR • Proteinuria (50% of patients) • Elevations in creatinine

  10. Supportive Laboratory DataDermatopathology • Histology varies • Typical is mild peri-vascular infiltrates with lymphocytes and histiocytes without vessel necrosis

  11. Differential Diagnosis • Acute Rheumatic Fever • Disseminated gonococcemia and meningococcemia • Reactive Arthritis (Reiter’s Syndrome) • Rickettsial Diseases • Disseminated EBV/CMV • Stevens-Johnson Syndrome • Still’s Disease • Kawasaki’s Disease • Viral Exanthems

  12. TreatmentStop offending agent • Mild symptoms self-limiting • Anti-histamines; NSAIDs • Severe symptoms (fever > 38.5; extensive rash, severe arthritis) give steroids • Avoid responsible drug in the future • Not clear if similar drugs should be avoided

  13. References • Lawley, TJ, Bielory, L, Gascon, P, et al. A prospective clinical and immunologic analysis of patients with serum sickness. N Engl J Med 1984; 311:1407 • Bielory, L, Yancey, KB, Young, NS, et al. Cutaneous Manifestations of serum sickness in patients receiving antithymocyte globulin. J AM Acad Dermatol 1985; 13:411 • Snow, M, Cannella, A, Stevens, RB, Presumptive Serum Sickness as a Complication of Rabbit-Derived Antithymocyte Globulin Immunosuppression • Harrison’s Textbook of Internal Medicine • Uptodate photography

More Related