Cutaneous manifestations of serum sickness in patients receiving antithymocyte globulin

L. Bielory, K. B. Yancey, N. S. Young, M. M. Frank, T. J. Lawley

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

We have prospectively evaluated the cutaneous manifestations of serum sickness in thirty-five patients treated with horse antithymocyte globulin for bone marrow failure. Twenty-one patients (21/35) were treated with antithymocyte globulin (15 mg/kg/day) for 10 days, and fourteen of thirtyfive patients were treated with antithymocyte globulin (15 mg/kg/day) for 14 days and then every other day for an additional 14 days. Clinical evidence of serum sickness developed in thirty patients and included fever and malaise (100%), cutaneous eruptions (93%), arthralgias and myalgias (67%), gastrointestinal complaints (67%), and lymphadenopathy (13%). Cutaneous findings consisted of morbilliform eruptions (n=19), urticaria (n=1), or a combination of these two reaction patterns (n=8). cutaneous manifestations of serum sickness began on day 7 ± 1 and lasted for 12 ± 2 days for the group as a whole. Biopsies of lesional skin revealed mild perivascular lymphohistiocytic infiltrates by light microscopy in these leukopenic patients. Direct immunofluorescence microscopy of lesional skin from patients with serum sickness demonstrated immunoreactants in seven of nine subjects (78%). Immunoreactants were confined to the walls of dermal blood vessels and consisted of IgM (7/9), C3 (6/9), IgE (5/9), and IgA (4/9). IgG (horse or human) was not identified in any of these specimens. Twenty-one patients (21/28) also developed an erythematous eruption on the sides of the fingers, toes, palms, and soles 12 to 48 hours prior to their morbilliform eruption. This study describes the cutaneous manifestations of human serum sickness occurring during therapy with horse antithymocyte globulin, documents a cutaneous sign of serum sickness, and suggests that the cutaneous eruptions associated with human serum sickness are immunologically mediated.

Original languageEnglish (US)
Pages (from-to)411-417
Number of pages7
JournalJournal of the American Academy of Dermatology
Volume13
Issue number3
StatePublished - 1985

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Serum Sickness
Skin Manifestations
Antilymphocyte Serum
Skin
Horses
Direct Fluorescent Antibody Technique
Myalgia
Urticaria
Arthralgia
Toes
Fluorescence Microscopy
Immunoglobulin A
Immunoglobulin E
Fingers
Immunoglobulin M
Blood Vessels
Microscopy
Fever
Immunoglobulin G
Bone Marrow

ASJC Scopus subject areas

  • Dermatology

Cite this

Cutaneous manifestations of serum sickness in patients receiving antithymocyte globulin. / Bielory, L.; Yancey, K. B.; Young, N. S.; Frank, M. M.; Lawley, T. J.

In: Journal of the American Academy of Dermatology, Vol. 13, No. 3, 1985, p. 411-417.

Research output: Contribution to journalArticle

Bielory, L. ; Yancey, K. B. ; Young, N. S. ; Frank, M. M. ; Lawley, T. J. / Cutaneous manifestations of serum sickness in patients receiving antithymocyte globulin. In: Journal of the American Academy of Dermatology. 1985 ; Vol. 13, No. 3. pp. 411-417.
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