DOI: 10.36347/sjmcr.2017.v05i10.005

Pages: 615-617

Aplastic anemia is a condition characterized by the absence or decrease of hematopoietic progenitor cells in the bone marrow. The disease is considered to occur as a result of immune response triggered by the environmental factors, infective agents or endogenous antigens. Cyclosporine and antithymocyte globulin is recommended as first line therapy in patients have no unidentified suitable donor or hematopoietic stem cell transplantation cannot be done. However, despite skin testing for hypersensitivity and concomitant steroids, adverse effects are sometimes unavoidable. 30-year-old female patient, fallowed with aplastic anemia since 2012, was admitted to hospital with painful swelling in the neck, rash and joint pain began after ATG. Laboratory examination revealed pancytopenia, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). C4 and C3 were lower in tests carried to show complement consumption. Skin biopsy was reported consistent with leucocytoclastic vasculitis. The diagnosis based on clinical and laboratory investigations: serum sickness triggered by h-ATG. Firstly; ATG and tacrolimus therapy was discontinued. Methylprednisolone was started. But plasmapheresis was performed due to failure to provide relief on clinical symptoms and implementation of the h-ATG will be continued until a suitable donor identified. Recovery was experienced after three sessions of plasmapheresis and the patient is discharged. We thought that; to contribute to the literature should always not be perceived as presenting a very rare case so we find worth sharing it with the hope of shedding light on the pathophysiology, managements and current treatment methods of serum sickness.