Serum Sickness-like Reaction - Pathogenesis

Pathogenesis

Serum sickness-like reaction is named for its clinical similarity to serum sickness, in which immune complexes are deposited in the skin, joints, and other organs. True serum sickness, a type III hypersensitivity reaction, results in fever, lymphadenopathy, arthralgias,cutaneous eruptions, gastrointestinal disturbances, proteinuria,and significant decreases in serum complement levels; it was originally described after patients were infused with equine immunoglobulins.

In contrast, serum sickness-like reactions are specific drug reactions that are not associated with circulating immune complexes.

Although the exact pathogenesis is poorly understood, serum sickness-like reactions are thought to originate from an abnormal inflammatory reaction that occurs in response to defective metabolism of drug byproducts generated during pharmacologic therapy; the metabolic flaw could be a maternally-inherited trait. In vivo hepatic drug biotransformation studies have shown greater lymphocyte killing in subjects with a known history of serum sickness-like reactions than in control subjects.

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Pathogenesis

The pathogenesis of a disease is the mechanism by which the disease is caused. The term can also be used to describe the origin and development of the disease and whether it is acute, chronic or recurrent. The word comes from the Greek pathos, "disease", and genesis, "creation".

Types of pathogenesis include microbial infection, inflammation, malignancy and tissue breakdown.

Most diseases are caused by multiple pathogenetical processes together. For example, certain cancers arise from dysfunction of the immune system (skin tumors and lymphoma after a renal transplant, which requires immunosuppression).

Often, a potential etiology is identified by epidemiological observations before a pathological link can be drawn between the cause and the disease.

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