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Serum Sickness Updated 4/2011

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BASICS

  • Description
  • Epidemiology
  • Risk Factors
  • Pathophysiology
  • Etiology
  • Associated Conditions

DIAGNOSIS

  • Signs and Symptoms
  • Tests
  • Differential Diagnosis

TREATMENT

  • Medication (Drugs)
  • Additional Treatment
  • In-patient Considerations

Ongoing Care

  • Follow-Up Recommendations
  • Diet
  • Patient Education
  • Prognosis
  • Complications
The following is an excerpt....
BASICS

Description
  • Serum sickness (SS): An acute type III hypersensitivity reaction; mediated by tissue deposition of IgG or IgM immune complexes:
    • Classically described 1–3 weeks following administration of nonhuman serum or after exposure to certain medications, with peak around day 10 postexposure
    • Most common current cause is exposure to nonprotein drugs such as penicillins and cephalosporins (1)
  • System(s) affected: Hematologic/Lymphatic/Immunologic; Musculoskeletal; Skin/Exocrine; Cardiovascular; Gastrointestinal (GI); Genitourinary
  • No sex or age predominance
  • Serum sicknesslike reaction (SSLR): A specific drug reaction not associated with immune complexes (see Commonly Associated Conditions)
Epidemiology

Incidence
  • Seen more commonly with β-lactam antibiotics; antibodies form against side chains
  • Rate of cefaclor serum sicknesslike reaction (SSLR) has been estimated at approximately 0 ...

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FIGURE 11.13 (A) Toxic epidermal necrolysis (TEN), a severe variant of erythema multiforme major, causes distinct blisters and a characteristic Nikolski sign (arrow) of normal appearing skin sloughing between the bullae. (B) Scalded skin with diffuse erythema appears more diffuse and when the skin sloughs, the underlying epidermis is often healed. (C) Graft versus host disease can be confused in appearance with TEN, but history of a recent transplant (solid or hematologic) is pathognomonic. (D) Removal of the sloughed skin and protection of the underlying viable wound bed by applying a biologic dressing such as xenograft improves survival in patients with TEN.Credit: Michael W. Mulholland, Ronald V. Maier etal. Greenfield's Surgery Scientific Principles And Practice, Fourth Edition. Philadelphia: Lippincott Williams & Wilkins, 2006.
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