Pediatric Serum Sickness Clinical Presentation

  • Author: Hanna Kim, MD, MS; Chief Editor: Harumi Jyonouchi, MD   more...
 
Updated: Feb 8, 2012
 

History and Physical Examination

History

The onset of serum sickness symptoms usually occurs 1-2 weeks after administration of the offending agent and correlates with the peak of circulating immune complexes. Fever, malaise, and headache are the earliest symptoms. Rash, joint pain, edema, gastrointestinal (GI) symptoms, arthralgia, and other symptoms follow.

Physical examination

The major physical findings include fever, rash, arthritis, and lymphadenopathy. The elevated temperature fluctuates between 37.5ºC and 40°C.

A rash is often the first clinical symptom and is frequently pruritic. If the causal agent was injected, the rash typically starts at the site of injection. Otherwise, the rash starts on the abdomen and spreads outward. Eruption over the rest of the body is usually symmetric and may take any of the following forms:

  • Urticaria (see image below)
  • Scarlatiniform rashMorbilliform rash
  • Polymorphous exanthema
  • Erythema, petechiae, or purpura with a serpiginous border at the margin of palmar plantar skin with the use of ATG[13] Urticarial rash in a child 10 days after cefaclor Urticarial rash in a child 10 days after cefaclor was administered for sore throat. Associated findings included fever, arthralgia of knees and ankles, and eosinophilia.

Approximately two thirds of patients experience joint discomfort.[38] In order of decreasing frequency, the affected joints include the knees, ankles, shoulders, wrists, spine, and temporomandibular joint. Joint fluid usually yields a moderately high number of white cells. Myalgias in the arms and thighs may also occur.

Lymphadenopathy coincides with the onset of other symptoms of serum sickness. Lymph nodes that receive drainage from the injection site enlarge and become tender. Other lymph nodes may also enlarge, sometimes to several centimeters in diameter.

Albuminuria, microscopic hematuria, and hyaline casts may be observed. Serum creatinine levels may transiently rise, and the creatinine clearance may decrease. Edema may be due to albuminuria or rash.

Nausea, vomiting, and abdominal pain are usually mild but may be confused with appendicitis and other GI disorders in children. Headache and blurred vision may develop. Uveitis has also been reported.[39] Other, rare symptoms include the following:

  • Cardiovascular problems - Pericardial effusion
  • Respiratory problems - Dyspnea, wheezing, cyanosis
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Hanna Kim, MD, MS  Clinical Associate in Pediatric Rheumatology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences

Hanna Kim, MD, MS is a member of the following medical societies: American Academy of Pediatrics and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Philip J Cohen, MD  Chief, Section of Dermatology, New Jersey Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Lawrence K Jung, MD  Chief, Division of Pediatric Rheumatology, Children's National Medical Center

Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD  Associate Professor, Division of Pulmonary, Allergy/Immunology, and Infectious Diseases, Department of Pediatrics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Mucosal Immunology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Robyn Siperstein, MD Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Robyn Siperstein, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for MOHS Surgery, and Sigma Xi

Disclosure: Nothing to disclose.

David J Valacer, MD Consulting Staff, Hoffman La Roche Pharmaceuticals

David J Valacer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association for the Advancement of Science, American Thoracic Society, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Urticarial rash in a child 10 days after cefaclor was administered for sore throat. Associated findings included fever, arthralgia of knees and ankles, and eosinophilia.
 
 
 
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