2012 Aug 10 – Serum sickness

Jui-Hung Ko MD, Dr Wen-Hung Chung MD.  The Lancet, Early Online Publication, 10 August 2012
Serum sickness
Showing multiple purpuric macules and confluent patches on both lower legs and feet.
A 61-year-old man was bitten by a poisonous snake (Taiwan bamboo viper, Viridovipera Stejnegeri) on his right hand 10 days before visiting our dermatology clinic. He received antivenom (polyvalent haemorrhagic) at our emergency department immediately after the accident. He had severe painful erythematous swelling of the right hand and forearm.

After intermittent infusion of high dose antivenom he developed fever and arthralgia on multiple large joints with skin rash. On examination, there were multiple non-blanchable, painful purpuric macular patches on both his lower legs and feet (figure). Laboratory tests showed that anti-nuclear antibody, C3, C4, and urinalysis were all within the normal range, except for a mild thrombocytopenia (platelets, 133×109 L). Skin biopsy showed leukocytoclastic vasculitis. The condition, known as serum sickness, is a type III immune complex hypersensitivity reaction that results from the injection of foreign protein or serum. Our patient received antihistamines and systemic corticosteroids and the skin rash resolved after 2 weeks.
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