Serum Sickness Like Disease in Children

Year 2020, Volume: 8 Issue: 3, 116 - 121, 25.12.2020

Vildan Güngörer Alaaddin Yorulmaz Ayşe Yüksel Şükrü  Arslan

https://doi.org/10.21765/pprjournal.840662

Abstract

Serum sickness and serum sickness-like reactions are the type 3 hypersensitivity reactions that occur in the presence of culprit agents which can be an exogenous protein, drug, bacteria, virus. Clinical symptoms usually begin in 6-21 days after exposure to antigenic stimulation. Typical clinical findings are characterised as fever (10-20%), erythematous rash (95%), polyarthritis and / or polyarthralgia (10-50%), and lymphadenopathy (10-20%). There are no specific laboratory findings and diagnostic criteria for serum sickness-like reaction. Laboratory findings usually include leukocytosis, mildly increased erythrocyte sedimentation rate, and rarely proteinuria and hematuria. Even though there are no diagnostic criteria for serum sickness-like reaction, it can be diagnosed with the presence of fever, rash, arthritis-arthralgia, lymphadenopathy, myalgia which occurs in 1-2 weeks after exposure to an agent that can trigger the disease. Recommended or achieved a consensus for the treatment of the serum sickness-like reaction doesn’t occur and the information about this subject in the literature is limited by the authors’ case reports who share their experiences.

Keywords

child, hypersensitivity, rash, serum sickness

Çocuklarda Serum Hastalığı Benzeri Reaksiyonlar

Abstract

Serum hastalığı ve serum hastalığı benzer reaksiyonlar belli antijenlerin varlığında ortaya çıkan tip III hipersensitivite reaksiyonudur. Semptomlar antijenik uyarıya maruziyet sonrası genelde 6-21 gün sonra başlar. Tip III hipersensitivite reaksiyonuna sebep olan antijen ekzojen yabancı bir protein, ilaç, bakteri, virüs olabilir. Tipik klinik bulgular ateş (%10-20), eritamatöz döküntü (%95), poliartrit ve/veya poliartralji (%10-50) ve lenfadenopati (%10-20) ile karakterizedir. Serum hastalığı benzeri reaksiyon için spesifik labaratuvar bulguları ve tanı kriteri bulunmamaktadır. Labaratuvar bulgularında genellikle lökositoz, hafif artmış eritrosit sedimentasyon hızı ve nadiren proteinüri ve hematüriyi içermektedir. Serum hastalığı benzeri reaksiyonun tanı kriterleri bulunmamakla birlikte hastalığı tetikleyebilecek bir ajana maruziyetten 1-2 hafta sonra gelişen, başka bir nedene bağlanamayan ateş, döküntü, artrit-artralji, lenfadenopati, myalji kliniği ile tanı konulur. Serum hastalığı benzeri reaksiyonda önerilen ve görüş birliği sağlanmış bir tedavi şekli bulunmamaktadır. Bu konuyla ilgili literatürde daha çok yazarların kendi deneyimlerini paylaştıkları vaka bildirimleri mevcuttur.

Keywords

çocuk, döküntü, hipersensitivite, serum hastalığı

References

• 1. Lundquist AL, Chari RS, Wood JH, et al. Serum sickness following rabbit antithymocyte globulin induction in a liver transplant recipient: case report and literature review. Liver Transpl. 2007;13: 647-50.
• 2. Gell PGH, Coombs RRA. Classification of allergic reactions responsible for clinical hypersensitivity and disease. In: Gell PGH, Coombs RRA, Hachmann PJ (eds). Clinical Aspects of Im - munology. Oxford, England: Blackwell Scientific Publications, 1975: 761-81.
• 3. Solensky R, Khan DA. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105:1-77.
• 4. Chen SM. Serum sickness. Emedicine Web site. http://www.emedicine. com/emerg/ Accessed February 19, 2008.
• 5. Johnson BA, Nunley JR. Use of systemic agents in the treatment of acne vulgaris. Am Fam Physician. 2000;62(8):1823-1830, 1835-1836.
• 6. Von Pirquet CF, Schick B. Die Serum Krankheit. Franz Deutiche Leipzig Wien 1905. (English translation by Schick B:Serum Sickness. Baltimore: Williams & Wilkins, 1951)
• 7. Apisarnthanarak A, Uyeki TM, Miller ER, et al. Serum sickness-like reaction associated with inactivated influenza vaccination among Thai health care personnel: risk factors and outcomes. Clin Infect Dis. 2009; 49: 18.
• 8. Arkachaisri T. Serum sickness and hepatitis B vaccine including review of the literature. J Med Assoc Thai. 2002; 85 2: 607.
• 9. Misirlioglu ED, Duman H, Ozmen S, et al. Serum sickness-like reaction in children due to cefditoren. Pediatr Dermatol. 2012;29: 327-8.
• 10. Sohail MA, Nasir J, Ikram U, et al. Serum Sickness-Like Reaction with Clarithromycin. Journal of Hospital Medicine. 2011;6: 231–232.
• 11. Parshuram CS, Phillips RJ. Retrospective review of antibioticassociated serum sickness in children presenting to a paediatric emergency department. Med. J. Aust. 1998; 169: 116.
• 12. Levine LR. Quantitative comparison of adverse reactions to cefaclor vs amoxicillin in a surveillance study. Pediatr. Infect. Dis. J.1985; 4: 358–61.
• 13. Dyall D, Smith FACD. Serum sickness-like reaction. Dermatologist; 2009.
• 14. Doan T, Melvold R, Viselli S, et al. İmmünoloji Lippincott. Nobel Matbaacılık, 2013, İstanbul.
• 15. Barnes P. Pathophysiology of Allergic Inflammation. In: Franklin N, Adkinson JR. William WB . editors. Middleton’s Allergy E-Book: Principles and Practice. 8th edition, Vol 1, Section A, Chapter 21.
• 16. Katta R, Anusuri V. Serum sickness-like reaction to cefuroxime: a case report and review of the literature. J Drugs Dermatol. 2007; 6: 747–748.
• 17. Brucculeri M, Charlton M, Serur D. Serum sickness-like reaction associated with cefazolin. BMC Clin Pharmacol. 2006; 6: 1-3.
• 18. Knowles SR, Uetrecht J, Shear NH. Idiosyncratic drug reactions: the reactive metabolite syndromes. Lancet 2000; 356:1587–1591.
• 19. D. Male, J. Brostoff, D. Roth, et al. Immunology 7th Ed. Elsevier, 2006.
• 20. Lawley TJ, Bielory L, Gascon P, et al. A prospective clinical and immunologic analysis of patients with serum sickness. N Engl J Med. 1984; 311:1407–1413.
• 21. Mathur AN, Mathes EF. Urticaria mimickers in children. Dermatol Ther. 2013; 26: 467–475.
• 22. Benjamin J, Makharia G, Ahuja V, et al. Glutamine and whey protein improve intestinal permeability and morphology in patients with Crohn’s disease: a randomized controlled trial. Dig Dis Sci. 2012;57: 1000–1012.
• 23. Lanas Á, Scarpignato C. Microbial flora in NSAID induced intestinal damage: a role for antibiotics? Digestion. 2006; 73: 136–150.
• 24. Linskens RK, Huijsdens XW, Savelkoul PH, et al. The bacterial flora in inflammatory bowel disease: current insights in pathogenesis and the influence of antibiotics and probiotics. Scand J Gastroenterol Suppl. 2001; 234: .29–40.
• 25. Spitz J, Hecht G, Taveras M, et al. The effect of dexamethasone administration on rat intestinal permeability: the role of bacterial adherence. Gastroenterology. 1994;106: 35–41.
• 26. Zhang Z, Xiang Y, Wang B, et al. Intestinal mucosal permeability of children with cefaclor-associated serum sickness-like reactions Eur J Pediatr. 2013; 172: 537–43.
• 27. Yerushalmi J, Zvulunov A, Halevy S. Serum sickness-like reactions. Cutis. 2002;69: 395-7.
• 28. Swanson J, English JC 3rd. Serum sickness-like reaction to Pamabrom. J Drugs Dermatol. 2006; 5: 284-6.
• 29. Parra F, Perez Elias M, Cuevas M, et al. Serum sickness-like illness associated with rifampicin. Ann Allergy. 1994;73: 123-5.
• 30. Tolpinrud WL, Bunick CG, King BA. Serum sicknesselike reaction: histopathology and case report. J Am Acad Dermatol. 2011; 65: 83–85.
• 31. Nguyen CV, Miller DD. Serum sickness-like drug reaction: two cases with a neutrophilic urticarial pattern. J Cutan Pathol. 2017; 44: 177–82.
• 32. Yorulmaz A, Akın F, Sert A, et al. Demographic and clinical characteristics of patients with serum sickness-like reaction. Clin Rheumatol. 2018; 37: 1389–94.
• 33. Diaz L, Ciurea AM. Cutaneous and systemic adverse reactions to antibiotics. Dermatol Ther. 2012; 25: 12–22.
• 34. King BA, Geelhoed GC. Adverse skin and joint reactions associated with oral antibiotics in children: the role of cefaclor in serum sickness-like reactions. J Paediatr Child Health. 2003; 39: 677–81.
• 35. Noguera-Morel L, Hernández-Martín Á, Torrelo A. Cutaneous drug reactions in the pediatric population. Pediatr Clin North Am. 2014; 61: 403-26.
• 36. Song JE, Sidbury R. An update on pediatric cu¬taneous drug eruptions. Clin Dermatol. 2014; 32: 516-23.
• 37. 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.
• 38. Bielory L, Gascon P, Lawley TJ, et al. Human serum sickness: a prospective analysis of 35 patients treated with equine anti-thymocyte globulin for bone marrow failure. Medicine (Baltimore). 1988; 67: 40.
• 39. McCollom RA, Elbe DH, Ritchie AH. Bupropion-induced serum sickness-like reaction. Ann Pharmacother. 2000; 34: 471-3.
• 40. Patterson-Fortin J, Harris CH, Niranjan-Azadi A, et al. Serum sickness-like reaction after the treatment of cellulitis with amoxicillin/clavulanate. BMJ Case Rep 2016. doi:10.1136/bcr-2016-217608.
• 41. Baniasadi S, Fahimi F, Mansouri D.Serum sickness-like reaction associated with cefuroxime and ceftriaxone. Ann Pharmacother 2007;41: 1318–1319.
• 42. Nayak S, Acharjya B. Adverse cutaneous drug reac¬tion. Indian J Dermatol 2008;53: 2-8.
• 43. Ralph ED, John M, Rieder MJ, et al. Serum Sickness–like Reaction Possibly Associated with Meropenem Use. Clinical Infectious Diseases 2003; 36: 149–51.
• 44. Vial T, Pont J, Pham E, et al. Cefaclor-associated serum sickness-like disease: eight cases and review of the literature. Ann Pharmacother. 1992; 26: 910.
• 45. Chiong FJK, Loewenthal M, Boyle M,et al. Serum sickness-like reaction after influenza vaccination. BMJ Case Rep 2015. doi:10. 1136/bcr-2015-211917.
• 46. Mathes EF, Gilliam AE. A four-year-old boy with fever, rash, and arthritis. Semin Cutan Med Surg. 2007; 26: 179-87.
• 47. Tatum AJ, Ditto AM, Patterson R. Severe serum sickness-like reaction to oral penicillin drugs: three case reports. Ann Allergy Asthma Immunol 2001; 86: 330-4.
• 48. Finger E, Scheinberg M. Development of serum sickness-like symptoms after rituximab infusion in two patients with severe hypergammaglobulinemia. J Clin Rheumatol. 2007; 13: 94.
• 49. LoVecchio F, Welch S, Klemens J, et al. Incidence of immediate and delayed hypersensitivity to Centruroides antivenom. Ann Emerg Med. 1999; 34: 615.
• 50. Joubert GI, Hadad K, Matsui D, et al. Selection of treatment of cefaclor-associated urticarial, serum sickness-like reactions and erythema multiforme by emergency pediatricians: lack of a uniform standard of care. Can J Clin Pharmacol. 1999; 6: 197.