RT Book, Section
A1 Shah, Ashish
A1 Sobolewski, Brad
A1 Mittiga, Matthew R.
A2 Knoop, Kevin J.
A2 Stack, Lawrence B.
A2 Storrow, Alan B.
A2 Thurman, R. Jason
SR Print(0)
ID 1181044480
T1 Serum Sickness–Like Reaction
T2 The Atlas of Emergency Medicine, 5e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260134940
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181044480
RD 2024/04/23
AB Serum  sickness–like  reaction  is  characterized  by  rash,  fever,  angioedema  of  the  face,  hands,  and  feet,  and  polyarthralgias/polyarthritis,  with  onset  1  to  2  weeks  following  exposure  to  an  offending  agent,  and  resolves  within  1  to  2  weeks  after  exposure  is  discontinued.  It  is  felt  to  occur  via  an  immune  complex–mediated  mechanism  and  can  be  precipitated  by  exposure  to  a  number  of  drugs,  with  trimethoprim-sulfamethoxazole,  cephalosporins,  and  penicillins  being  most  common.  Almost  all  patients  develop  a  polymorphous  pruritic  rash  that  starts  in  the  trunk,  groin,  and  axillae,  eventually  spreading  to  the  limbs.  The  urticarial  lesions  are  longer  lasting  than  typical  hives.  Some  patients  can  exhibit  palpable  purpura,  maculopapular  lesions,  or  target  lesions  reminiscent  of  erythema  multiforme  but  without  evidence  of  blister  formation.  In  all  patients,  the  mucous  membranes  are  spared.  Almost  all  patients  develop  remittent  fever  without  temporal  spikes.  Other  symptoms  include  arthralgias,  angioedema,  and  rarely,  frank  arthritis.  The  differential  diagnosis  includes  viral  exanthems,  hypersensitivity  vasculitis,  scarlet  fever,  acute  rheumatic  fever,  meningococcemia,  disseminated  gonococcemia,  reactive  arthritis,  Lyme  disease,  Still  disease,  and  Stevens-Johnson  syndrome.