Case records of the Massachusetts General Hospital. Case 10-2013. A 30-year-old man with fever, myalgias, arthritis, and rash

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

Serum sickness is a well-known immune complex deposition phenomenon, occurring as a reaction to proteins in antiserum from a non-human animal source. Serum sickness-like reaction (SSLR), typically associated with drugs and vaccines, sometimes occurs with acute hepatitis B infection and poses a diagnostic dilemma for clinicians, as other viral syndromes, vasculitic processes, and autoimmune conditions can have similar presentations. We present a 36-year-old intravenous drug user, with confirmed records of hepatitis B immunization, who presented with multi-joint pain, joint swelling, and a skin rash. There is a paucity of cases in the literature reporting occurrence of serum sickness-like reaction due to acute hepatitis B infection in a previously fully-immunized adult. This diagnosis should be kept in mind even in the clinical scenario of a fully-immunized patient.

Rheumatoid Arthritis-like Disorder Mimicking Serum Sickness: Do Not Forget Acute B Hepatitis!

We report on a patient who presented with a severe symmetric polyarthritis that was found to be part of the prodromal stage of acute hepatitis B. This syndrome is seen in a minority of cases, resembles serum sickness and parallels the duration and level of hepatitis B viremia. It is a type III immune complex reaction with complement consumption and activation which ultimately triggers inflammation and may also occur in the context of other infections, vaccines, and use of antibiotics or sera. We emphasize the need to search for acute B hepatitis in all patients with polyarthritis or other symptoms of serum sickness.