illness known as serum sickness is an example of an immune complex type III
hypersensitivity. It has traditionally resulted from the administration of
therapeutic antisera of animal sources for the treatment or prevention of
infectious diseases, such as tetanus, pneu-monia, rabies, diphtheria, botulism,
and venomous snake and black widow spider bites. With the advent of human
antitetanus serum and antibiotics, classic serum sickness is much less common
now. However, various medications (primarily penicillin) may cause a serum
sickness–like reaction similar to that caused by foreign sera.
are due to a reaction and immunologic attack on the serum or medication.
Antibodies appear to be of the IgE and IgM classes. Early manifestations,
beginning 6 to 10 days after the ad-ministration of the medication, include an
inflammatory reaction at the site of injection of the medication, followed by
regional and generalized lymphadenopathy. There is usually a skin rash, which
may be urticarial or purpuric. Joints are frequently tender and swollen.
Vasculitis may occur in any organ but is most commonly observed in the kidney,
resulting in proteinuria and, occasionally, casts in the urine. There may be
mild to severe cardiac involvement. Peripheral neuritis may cause temporary
paralysis of the upper ex-tremities or may be widespread, causing
usual course lasts for several days to a few weeks if untreated, but the
patient responds promptly and completely if treated with antihistamines and
corticosteroids. Aggressive therapy, including ventilator support, may be
necessary if peripheral neuritis and Guillain-Barré syndrome occur.