Rivaroxaban-induced serum sickness after total knee arthroplasty

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
David J Snyder, F Bahar Matusik

Abstract

A case of serum sickness or serum sicknesslike reaction (SSLR) in a patient receiving rivaroxaban for venous thromboembolism (VTE) prophylaxis after undergoing elective right total knee arthroplasty (TKA) is reported. A 61-year-old man arrived at the emergency department from a short-term rehabilitation facility 12 days after a right TKA with complaints of fever, chills, bilateral forearm pain, swelling in the extremities, and a diffuse erythematous rash with welts on his back. Rivaroxaban was initiated on postoperative day 1 for VTE prophylaxis and was discontinued on day 10 of therapy, when symptoms began to appear. His renal function was within normal limits; however, his alanine transaminase level was twice the upper limit of normal. The patient was admitted to the inpatient medical service and placed on intravenous fluids, subcutaneous heparin for VTE prophylaxis, supportive therapy for his symptoms, and his home medications. After 2 days of observation, the rheumatology and immunology services were consulted to assess the patient. Due to the patient's fever, myalgias, mild transaminitis, diffuse erythematous rash, and depressed total serum complement, it was determined that the patient had serum sickness secondary to trea...Continue Reading

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Citations

Aug 15, 2017·Journal of Pharmacy Practice·Evan SassonHenry Cohen
Jan 20, 2018·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Kelly M RuddAnush Patel

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