Serum Sickness - CRASH! Medical Review Series

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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)

[@HockeyGuy_in_STL]

Fabulous review, thank you. Respectfully requesting that "TCP" not be used for thrombocytopenia, as it is not an approved or even a common abbreviation for this condition. TCP stands for Transmission Control Protocol, an internet protocol. Kawasaki's Disease may be complicated by coronary artery aneurysms (not embolism, at t=25:20 of the video).

[@bre1263]

Very informative, greatly helped my understanding.
Thanks

[@DrDinooshDeLivera]

Thank you Dr Bolin, Your work is awesome!

[@rasputinrevelaciones2914]

Good work

[@Darus2013]

Thanks very informative! Our son got diagnosed from the hospital with Serum Sickness on his 2 birthday today (dec 15) from the amoxicillin he had finished 5 days earlier. The doctor at the clinic yesterday told me it was a reaction to maybe something he ate. ..

[@woloabel]

Pediatrics: Serum Sickness (SS) and Serum Sickness Like Reaction (SSLR) are Hypersensitivity Reactions (HS), namely HS Type III. Treatment is Symptomatic and Avoidance (Physician Annotation for Future Reference). Clinical Presentation is 1) Fever/Malaise (100%) 2) Arthralgia (77%) 3) Myalgia (37%) 4) Lymphadenopahty (LAN, 17%) systemically; Cutaneous: 1) Rash (Urticarial Rash/Pruritic Rash, 93%), 3) Erythema Multiforme Morphology occasionally, 4) Petechiae/Purpura. Head/Eyes/Ears/Nose/Throat (HEENT) Manifestations: 1) Migraine, 2) Blurred Vision; Pulmonary Signs: 1) Dyspnea/Wheezing (20%), 2) Pleuritis/Pleursy is a rare occurrence; Cardiovascular Manifestations: 1) Pericarditis (Rarely), 2) Myocarditis (Rare); Gastrointestinal Signs Possible: 1) General Complaints (67%), as in 2) Abdominal Pain, 3) Nausea, 4) Vomiting/Emesis, 5) Diarrhea; Neurological 1) Peripheral Neuropathy, 2) Optic Neuritis, 3) Cranial Nerve Palsies, 4) Guillane Barre Syndrome rarely. This is a Pathology diagnosed Clinically (CBC: Thrombocytopenia, Leukocytosis (Low or High); PBS: Plasma Cells Present; 2) Transient Creatinine Elevation, 3) ESR Elevation, 4) UA: Hematuria and Mild Proteinuria (Not Nephrotic Syndrome), 5) Complement Studies C3, C4 Decreases would be Laboratories Findings however). Differential Diagnosis (DDx): 1) Henoch-Scholein Purpura (HSP) will always show Hemorrhage following a Upper Respiratory Tract Infection (URTI) History and Rash Progression is distinctive. 2) Kawasaki Disease (KD) is a Pediatric Pathology (90 are less than 5YOA); Palmar/Pedal Rash; Distinctive Oropharyngeal Signs (1 Lip Fissures/Crusting, 2) Strawberry Tongue Morphology) and Conjunctival Injection (90%); 3) Cryoglobinemia is a Mimic of SS/SSLR and HSP but Coexists with an Infection or Autoimmunity Disease. Cold Purpura (Hemorrhage of Cold Exposure) is more frequent than Urticaria with Respiratory Symptoms (Dyspnea and Pleuritic Pain). 4) Microscopic Polyangiitis is found in Older Subjects (50+) with Fever (Less common than SS/SSLR). Mononeuritis Multiplex and Weight Loss are Common. 5) Dermatitis Herpetiformis (DH) has Pruritic Rash but is also Blistering. Symptoms are strictly Cutaneous. Celiac Disease (History and Symptoms) is a Possibility for which GI Consultation is Necessary. 6) Infectious Mononucleosis is common with Fever, Myalgia and Malaise with Pharyngitis and Lymphadenopathy are Pathognomonic for this Viral Pathology (Epstein-Barr Virus). Treatment/Management: Self-Limited Disease with complete Resolution in few Weeks and upon Withdrawal of the Allergen (Medication). Follow-Up is indicated however. 2) NSAIDs for Pain (Joint Pain) and Fever as needed. 3) PRN Antihistamines for Pruritus and Urticaria. 4) 2-4 Week Follow-up. 5) Corticosteroids for Severe Cases ( Cardiopulmonary/Vascular Involvement or Neurological). 6) Unclear Diagnosis merits Admission or ( 1) Cardiovascular symptoms (Hypotension/Tachycardia), 2) Old Age Comorbidity, 3) Immunocompromised Subjects). Goodness, this is a bad reaction while Idiosyncratically logical. I suspect Malicious Foul Play in these so-called Hypersensitivities but it is just an expert Opinion....MD Paul Bolin es geht gut aber man muss nur sich helfen. Prost!

[@xDomglmao]

Thank you very much!

[@xDomglmao]

12:01 Hmm, Uni of Louisville lecture said: urticaria + fever+arthralgia but NOT immune complex deposition so NOT low C, vasculitis, or renal disease (these are features of true serum sickness)
EDIT: Ok, I see the issue now. Seems like renal disease etc are all rare in true SS

[@JesseKlaus]

Too bad our pediatrician didn't watch this video. Seven days into a ten day treatment they tried to say our son was only experiencing an allergic reaction and said it should stop after ceasing treatment. Also as you pointed out, fever is a dead giveaway.

[@xDomglmao]

Sorry to hear that. Which city/ region?

[@lunitaabonita]

Would having Serum Sickness make your blood labs/test positive for bacteria????

[@xDomglmao]

I would say: No unless false positive (because it is a hypersensitivity, not an infection)