Serum sickness in Child
Alerts and Notices
SynopsisSerum sickness is a type 3 immune complex disease resulting from exposure to therapeutic heterologous (classically nonhuman) serum or chimeric therapeutic proteins. The reaction is also rarely observed after blood transfusions. Serum sickness typically occurs 7-21 days after exposure to exogenous proteins or chemicals. Inciting agents include microbial and venom antitoxins, immunomodulators, vaccines, insect stings, therapeutic fibrinolytic proteins, and allergy immunotherapy.
Antigens induce antibody production, resulting in circulating antigen-antibody complexes that deposit within postcapillary venules. Subsequent complement activation releases vasoactive amines and cytokines, leading to symptoms and signs that include urticaria (often first noticed at the site of injection), fever, myalgias, arthralgias, arthritis, and lymphadenopathy.
Risk factors for the development of serum sickness include a higher dose of the medication, certain preparations, repeated exposure, older age, cryoglobulinemia or hypergammaglobulinemia, and an intermittent dosing schedule. Children are less likely to get serum sickness reaction than adults; however, it is high on the differential for a teenager with arthritis.
The disease is usually self-limited and lasts less than one week. Patients may also complain of gastrointestinal tract symptoms including nausea, vomiting, diarrhea, and melena. Renal (glomerulonephritis), cardiac (carditis), and neurologic (Guillain-Barré syndrome, peripheral neuritis) sequelae occur rarely. Previously sensitized hosts can see an accelerated onset of symptoms occurring 1-3 days after exposure to the antigen.
Related topic: Serum sickness-like reaction
T80.69XA – Other serum reaction due to other serum, initial encounter
72284000 – Serum sickness
Differential Diagnosis & Pitfalls
- Systemic lupus erythematosus
- Serum sickness-like reaction (incited by nonprotein drugs)
- Rocky Mountain spotted fever
- Leukocytoclastic vasculitis
- Exanthematous drug eruption
- Hereditary angioedema
- Drug hypersensitivity syndrome (drug rash with eosinophilia and systemic symptoms [DRESS])
- Erythema multiforme
- Urticaria or urticaria multiforme
- Infective endocarditis
- Urticarial vasculitis
- Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
- Kawasaki disease – Kawasaki disease presents in infants and children. Cutaneous manifestations include erythematous urticarial plaques, acral and groin edema, and desquamation of the palms and soles. Patients also have mucosal involvement not present in serum sickness, such as conjunctivitis and strawberry tongue. Scalloped erythema at the sides of the hands and feet may be seen.
- Acute hemorrhagic disease of infancy
- Viral exanthem – Viral exanthems rarely present with arthralgias and occasionally have mucosal involvement. Serum sickness is unlikely to have mucosal involvement.
- Acute rheumatic fever (ARF) – In ARF, the arthritis is migratory, and patients may have cardiac involvement.
- Lyme disease
- Gonococcemia – Patients appear much more ill, with pustules; pustules are not present in serum sickness.
- Reactive arthritis
- Scarlet fever
- Systemic onset juvenile idiopathic arthritis – The rash is a salmon-colored, fleeting rash that is associated with fever and resolves within hours. These patients do not get better without treatment, whereas serum sickness is self-limited.
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Serum sickness in Child