A 34-year-old woman with end-stage kidney disease secondary to IgA nephropathy is undergoing kidney transplant from an unrelated living donor. The patient receives induction immunosuppression with a rabbit antithymocyte globulin-based regimen immediately prior to the procedure. The surgery is performed without complications, and maintenance immunosuppressive therapy is begun. Ten days later, the patient experiences high fevers, generalized pruritic rash, and pain, redness, and swelling of the bilateral metacarpophalangeal joints, wrists, and knees. The erythrocyte sedimentation rate is elevated. Arthrocentesis of the involved joint yields synovial fluid with neutrophilic leukocytosis; there are no crystals and no bacteria on Gram stain. Which of the following is most likely responsible for the increased synovial membrane permeability in this patient?

Question

A 34-year-old woman with end-stage kidney disease secondary to IgA nephropathy is undergoing kidney transplant from an unrelated living donor.  The patient receives induction immunosuppression with a rabbit antithymocyte globulin-based regimen immediately prior to the procedure.  The surgery is performed without complications, and maintenance immunosuppressive therapy is begun.  Ten days later, the patient experiences high fevers, generalized pruritic rash, and pain, redness, and swelling of the bilateral metacarpophalangeal joints, wrists, and knees.  The erythrocyte sedimentation rate is elevated.  Arthrocentesis of the involved joint yields synovial fluid with neutrophilic leukocytosis; there are no crystals and no bacteria on Gram stain.  Which of the following is most likely responsible for the increased synovial membrane permeability in this patient?

Quizplus · Accepted Answer

Eductional Objective: Serum sickness is an immune complex-mediated, type III hypersensitivity reaction that occurs when immune complexes deposit in skin and joints and activate the classical complement cascade.  This generates the highly inflammatory anaphylatoxins C3a and C5a, leading to skin rash, joint arthralgia/arthritis, and high fever.

A 34-Year-Old Woman with End-Stage Kidney Disease Secondary to IgA