Serum Sickness-Like Reaction Associated With Acute Hepatitis B in a Previously Vaccinated Adult Male

Gupta, Rahul; Fakunle, Ibukun; Samji, Varun; Hale, Elizabeth B

doi:10.7759/cureus.14742

Cited by 2 publications

(5 citation statements)

References 3 publications

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“…Hepatitis B vaccine, which contains viral proteins, has also been associated with the development of serum sickness in rare cases [ 20 ]. The clinical presentation varies widely and includes fever, rashes (erythematous maculopapular or macular rash, urticarial, nodular, petechial), and polyarthritis with laboratory findings of low levels of complement [ 1 , 21 ]. The symptoms can occur before the onset of viral symptoms of acute HBV infection [ 2 ].…”

Section: Systemic Diseasesmentioning

confidence: 99%

Burden, Outcome, and Comorbidities of Extrahepatic Manifestations in Hepatitis B Virus Infections

Songtanin,

Chaisrimaneepan,

Mendóza

et al. 2024

Viruses

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Hepatitis B virus (HBV) infections affect approximately 296 million people around the world, and the prevalence of any past or present HBV infection during the years 2015–2018 was as high as 4.3%. Acute HBV infection often presents with nonspecific symptoms and is usually self-limited, but 5% of patients can have persistent infections leading to chronic HBV infection and the risk of turning into chronic HBV infection is significantly higher in babies with vertical transmission (95%). Patients with chronic HBV infection are usually asymptomatic, but 15 to 40% of chronic HBV carriers develop cirrhosis and/or hepatocellular carcinoma. In addition to liver-related disorders, HBV is also associated with several extrahepatic complications, including glomerulonephritis, cryoglobulinemia, neurologic disorders, psychological manifestations, polyarthritis, and dermatologic disorders. Making the diagnosis of HBV can be challenging since patients with chronic infections can remain symptom-free for decades before developing cirrhosis or hepatocellular carcinoma, and patients with acute HBV infection may have only mild, nonspecific symptoms. Therefore, understanding how this virus causes extrahepatic complications can help clinicians consider this possibility in patients with diverse symptom presentations. The pathophysiology of these extrahepatic disorders likely involves immune-related tissue injury following immune complex formation and inflammatory cascades. In some cases, direct viral infection of extrahepatic tissue may cause a clinical syndrome. Currently, the American Association for the Study of Liver Diseases recommends treatment of chronic HBV infections with interferon therapy and/or nucleos(t)ide analogs, and this treatment has been reported to improve some extrahepatic disorders in some patients with chronic HBV infection. These extrahepatic complications have a significant role in disease outcomes and increase medical costs, morbidity, and mortality. Therefore, understanding the frequency and pathogenesis of these extrahepatic complications provides important information for both specialists and nonspecialists and may help clinicians identify patients at an earlier stage of their infection.

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Section: Systemic Diseasesmentioning

confidence: 99%

Burden, Outcome, and Comorbidities of Extrahepatic Manifestations in Hepatitis B Virus Infections

Songtanin,

Chaisrimaneepan,

Mendóza

et al. 2024

Viruses

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“…Клиническая картина данного состояния идентична истинной сывороточной болезни, однако последняя обусловлена развити-ем аллергической реакции типа III [2]. Патогенез SSLR остается малоизученным, а само заболевание ассоциировано с реакцией на лекарственные препараты [3], вакцины [4], вирусные и бактериальные инфекции [5]. Заболевание характеризуется специфическими кольцевидными элементами, лихорадкой, полиартритом, полиартралгиями и благоприятным прогнозом с самостоятельным разрешением высыпаний при устранении действия провоцирующего фактора [6,7].…”

Section: обоснованиеunclassified

“…Заболевание редко диагностируется, так как часто ошибочно принимается за другие дерматозы (крапивница, многоформная экссудативная эритема, вирусные экзантемы, лекарственные реакции), которым присущи кольцевидные и полициклические высыпания [3]. Вместе с тем, для SSLR характерны внезапное появление кожной сыпи и поражение суставов, с лихорадкой или без нее, которым предшествуют прием (чаще всего) лекарственных средств [10], инфекция [5] или вакцинации [11]. Наиболее частая причина SSLR -␤-лактамные антибиотики, особенно цефаклор и амоксициллин, однако подобные реакции были описаны и при применении сульфаниламидных, противоопухолевых и противоэпилептических препаратов, НПВП [3], а в последнее время -и генно-инженерных биологических препаратов [12].…”

Section: предварительный диагнозunclassified

“…Наиболее частая причина SSLR -␤-лактамные антибиотики, особенно цефаклор и амоксициллин, однако подобные реакции были описаны и при применении сульфаниламидных, противоопухолевых и противоэпилептических препаратов, НПВП [3], а в последнее время -и генно-инженерных биологических препаратов [12]. Причинами SSLR могут быть и вирусные инфекции, в частности возбудители гепатита В и С [5]. В описанном нами случае причиной SSLR, вероятнее всего, явилась инфекция ВЭБ, так как на момент дебюта заболевания пациентка не получала лекарственных препаратов, которые могли бы спровоцировать SSLR, а при проведении серологического исследования был выявлен высокий титр IgM к ВЭБ.…”

Section: предварительный диагнозunclassified

“…4). Повышение титра IgG к ВЭБ, а также наличие IgM к ВЭБ в начале заболевания указывает на ВЭБ как на возможный триггер SSLR, так как в литературе ранее была описана связь между вирусными инфекциями и подобной реакцией[5]. Результаты ультразвукового исследования органов брюшной полости и почек, элек-трокардиографии и эхокардиографии соответствовали возрастной норме.Учитывая удовлетворительное состояние и отсутствие значимых лабораторных и инструментальных отклонений для купирования артралгий пациентке был назначен ибупрофен в дозировке 200 мг 3 раза/сут.…”

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Serum Sickness-Like Reaction Associated with Epstein – Barr Virus: Clinical Case

Ivanchikov

Мурашкин

Амбарчян

et al. 2022

Vopr. sovr. pediatr.

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Background. Annular dermatoses are a group of diseases with major clinical manifestation of rashes of relevant form. This manifestation pattern causes difficulties in diagnosis. The case of rarely diagnosed annular dermatosis is presented: serum siknesslike reaction (SSLR) triggered by the Epstein – Barr virus (EBV). Clinical case description. Patient D., 8 years old girl, noted abdominal pain 3 weeks before hospitalization, and later numerous polymorphic rashes (erythematous macules, urticarial elements), swelling and pain in joints. Self-treatment with non-steroidal anti-inflammatory and systemic antihistamines did not lead to any improvement. The patient was hospitalized in the pediatric department at the place of residence, where the diagnosis “Henoch-Schonlein purpura, mixed type” was established according to the results of physical, laboratory (double increase of ALT and AST, ESR up to 166 mm/h, IgM to EBV), and ultrasound (mesenteric lymph nodes hyperplasia) studies. Systemic glucocorticosteroids have led to improvement, however, few days after the end of the treatment there was relapse of rash and arthralgia. Thus, the girl was administrated to clinical diagnostic center. Patient’s general condition was satisfactory at the time of examination. There were numerous erythematous annular urticarial and macular elements (3–12 cm) on the skin of face, body and limbs. Some foci, as well as some resolved rashes had blue spots with indistinct boundaries that disappeared after compression. Mucous membranes, nails and hair were intact. Subjective symptoms — slight burning around rashes, at palpation — low-intensity pain in the left radiocarpal joint. Blood tests: C-reactive protein concentration increased up to 12 mg/L, ESR up to 26 mm/h, IgG to EBV up to 47.7. Conclusion. During differential diagnosis we should consider the possibility of SSLR development in all pediatric patients with annular rashes associated with arthralgia and/or arthritis, fever, history of drug use (most often beta-lactam antibiotics), recent vaccination or manifestations of viral infection, especially in case of cyanotic spots after rashes resolution and non-specific laboratory parameters.

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Serum Sickness-Like Reaction Associated With Acute Hepatitis B in a Previously Vaccinated Adult Male

Cited by 2 publications

References 3 publications

Burden, Outcome, and Comorbidities of Extrahepatic Manifestations in Hepatitis B Virus Infections

Burden, Outcome, and Comorbidities of Extrahepatic Manifestations in Hepatitis B Virus Infections

Serum Sickness-Like Reaction Associated with Epstein – Barr Virus: Clinical Case

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