Type III hypersensitivity and immune complexes
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A 29-year-old patient with aplastic anemia receives horse-derived antithymocyte globulin. Eleven days after treatment begins, fever, a diffuse rash, painful swollen wrists, and cervical lymphadenopathy develop. Urinalysis shows protein and red blood cell casts. Serum C3 and C4, previously normal, are decreased. A skin biopsy shows neutrophils and immunoglobulin deposits in small-vessel walls.