eMedicine Specialties > Emergency Medicine > Allergy & Immunology

Serum Sickness: Differential Diagnoses & Workup

Author: Susan M Chen, MD, Clinical Assistant Professor, Department of Emergency Medicine, University of Pennsylvania Health System, Penn Presbyterian Medical Center
Contributor Information and Disclosures

Updated: Jul 9, 2009

Differential Diagnoses

Erythema Multiforme
Mononucleosis
Polymyositis
Systemic Lupus Erythematosus
Tick-Borne Diseases, Rocky Mountain Spotted Fever
Toxic Epidermal Necrolysis

Other Problems to Be Considered

Dermatomyositis
Drug-related exanthema
Drug-induced arthritis and arthralgias
Leukemia
Leukocytoclastic vasculitis
Lymphoma
Urticarial vasculitis

Workup

Laboratory Studies

Although laboratory studies are not helpful in establishing a diagnosis of serum sickness, certain laboratory findings have been reported.

  • Complement levels (determined outside the ED) vary.
  • CBC and differential tests may reveal leukocytosis or leukopenia with or without eosinophilia.
  • The erythrocyte sedimentation rate usually is slightly elevated.
  • Serum protein electrophoresis (performed outside the ED) may reveal hypergammaglobulinemia with free circulating light chains.
  • Urinalysis may reveal proteinuria and/or hematuria.

More on Serum Sickness

Overview: Serum Sickness
Differential Diagnoses & Workup: Serum Sickness
Treatment & Medication: Serum Sickness
Follow-up: Serum Sickness
References
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References

  1. Benson E. Bupropion-induced hypersensitivity reactions. Med J Aust. Jun 18 2001;174(12):650-1. [Medline].

  2. Wooltorton E. Bupropion (Zyban, Wellbutrin SR): reports of deaths, seizures, serum sickness. CMAJ. Jan 8 2002;166(1):68. [Medline].

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  7. Bigby M, Stern RS, Arndt KA. Allergic cutaneous reactions to drugs. Prim Care. Sep 1989;16(3):713-27. [Medline].

  8. Erffmeyer JE. Serum sickness. Ann Allergy. Feb 1986;56(2):105-9. [Medline].

  9. Hart FD. Drug-induced arthritis and arthralgia. Drugs. Oct 1984;28(4):347-54. [Medline].

  10. Heckbert SR, Stryker WS, Coltin KL, Manson JE, Platt R. Serum sickness in children after antibiotic exposure: estimates of occurrence and morbidity in a health maintenance organization population. Am J Epidemiol. Aug 1990;132(2):336-42. [Medline].

  11. Lawley TJ, Bielory L, Gascon P, Yancey KB, Young NS, Frank MM. Human serum sickness. Trans Assoc Am Physicians. 1984;97:49-55. [Medline].

  12. Naguwa SM, Nelson BL. Human serum sickness. Clin Rev Allergy. Feb 1985;3(1):117-26. [Medline].

  13. Parker CW. Allergic reactions in man. Pharmacol Rev. Mar 1982;34(1):85-104. [Medline].

  14. Platt R, Dreis MW, Kennedy DL, Kuritsky JN. Serum sickness-like reactions to amoxicillin, cefaclor, cephalexin, and trimethoprim-sulfamethoxazole. J Infect Dis. Aug 1988;158(2):474-7. [Medline].

  15. Reynolds JS. Serum sickness: an old problem with new implications. Ann Allergy. Jul 1966;24(7):337-44. [Medline].

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Further Reading

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Keywords

serum sickness, hypersensitivity reaction, type III hypersensitivity reaction, serum sickness reactions, foreign protein injection, antitoxin, tetanus horse serum, rabies horse serum, heterologous serum

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Contributor Information and Disclosures

Author

Susan M Chen, MD, Clinical Assistant Professor, Department of Emergency Medicine, University of Pennsylvania Health System, Penn Presbyterian Medical Center
Susan M Chen, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Matthew M Rice, MD, JD, FACEP, Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians; Assistant Clinical Professor of Medicine, University of Washington at Seattle
Matthew M Rice, MD, JD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Washington State Medical Association
Disclosure: Team Health  Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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