QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ashraf-Benson, S. Articles by Veach, L. A Search for Related Content PubMed PubMed Citation Articles by Ashraf-Benson, S. Articles by Veach, L. A

Serum Sickness–Like Reaction Associated with Efalizumab

Post-Graduate Year-2 Medical Resident, Iowa Methodist Medical Center (IMMC), Des Moines, IA

Geoffrey C Wall, PharmD BCPS CGP

Internal Medicine Clinical Pharmacist, IMMC; Associate Professor of Pharmacy Practice, College of Pharmacy and Health Sciences, Drake University, Des Moines

Lisa A Veach, MD

Infectious Diseases Physician, IMMC; Clinical Associate Professor, Department of Internal Medicine, College of Medicine, University of Iowa, Iowa City, IA

Reprints: Dr. Wall, Department of Pharmacy, Iowa Methodist Medical Center, 1200 Pleasant St., Des Moines, IA 50309, fax 515/241-5085, Geoff.wall{at}drake.edu

OBJECTIVE: To report a case of serum sickness–like reaction (SSLR) possibly induced by efalizumab, a recombinant humanized immunoglobulin G1 isotype monoclonal antibody approved for treatment of moderate-to-severe plaque psoriasis.

CASE SUMMARY: A 37-year-old woman with plaque psoriasis who had been treated with efalizumab for 2 months developed a fever, erythematous rash, and progressive joint swelling and pain that required hospitalization. An exhaustive workup for infectious and rheumatologic causes of the patient's symptoms was negative. Given the relative temporal relationship between efalizumab therapy and the patient's signs and symptoms, a diagnosis of serum sickness was made. Systemic corticosteroids were initiated, which resulted in rapid resolution of the patient's signs and symptoms. Use of an objective causality assessment suggests that the patient's SSLR was possibly related to efalizumab.

DISCUSSION: Like many therapeutic monoclonal antibodies, efalizumab is associated with several adverse events, including allergic reactions. SSLR, a nonimmediate hypersensitivity syndrome, can occur with a variety of drugs including monoclonal antibodies. However, a MEDLINE search (1964–July 2008) identified only one other possible case of SSLR related to efalizumab.

CONCLUSIONS: Clinicians using efalizumab should be aware of this possible adverse reaction.

Key Words: efalizumab, serum sickness

Published Online, January 27, 2009. www.theannals.com, DOI 10.1345/aph.1L495