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Transcript
Antonio M. Cruz, M.D. Module Leader- Immunopathology The following cases are illustrations of the different immune conditions/diseases representative of each. It is important to: 1. Identify the immune mechanism 2. Explain the pathophysiology 3. Discuss the clinicopathologic correlation A tuberculin skin test results in a firm 25 mm diameter dark red firm area of induration on the forearm that appears 60 hours following injection of the PPD. Tuberculin Test site evaluated after 48-72 hours. 2.5 cm Indurated papule 1. Intradermal Injection of antigen (PPD) Dendritic APC ***** * 4-6 days T cell 2. Antigen processing Blood vessel 3. T cell activation 4. Cytokine release * * *** * Diadepesis Activated T cell 5. FORMATION OF INFILTRATE This finding is most likely to be a consequence of which of the following types of immune reaction? A. Immediate type hypersensitivity response B. Anti-receptor antibody formation C. Complement dependent hypersensitivity D. Antibody-dependent cell mediated cytotoxicity E. Delayed type hypersensitivity p.205-208 A 32-year-old woman develops a butterflyshaped erythematous rash over the malar area when she spends several hours outside her home at her garden. A urinalysis is performed that shows moderate numbers of red blood cells and 2+proteinuria. A skin biopsy shows positive immunofluorescence along the dermal-epidermal junction with antibody to C1q. A renal biopsy was later performed . Discuss the mechanisms for the development of the rash and the skin biopsy findings. (p.219) Discuss the cause of the renal changes. (p.217-218) p. 219 Liquefactive necrosis Upper dermis of a patient showing inflammatory infiltration. The basal layer of epidermis is undergoing vacuolization and dissolution, and there is purpura with RBCs extravasated into the upper dermis. [Elizabeth Hammond, MD, University of Utah] p.219 Band-like immunofluorescense at dermoepidermal junction using antibody to C1q. p.219 Diffuse Proliferative GN p.219 IF with IgG p.218 PAS stain p.219 “Wire loop” lesions due to extensive subendothelial deposits Within minutes following a bee sting, a 20 year old male develops dyspnea. Examination of the laryngeal tissues shows edema. Laryngeal edema The chemical substance most likely to be responsible for this finding is: A. Nitric oxide B. Prostaglandin E2 C. Complement fragment C3b D. Histamine (DI KO SURE!) E. Leucotriene What type of hypersensitivity reaction is this? Type I Discuss the sequence of events that lead to sensitization and the immediate immune response. (p.198-201) Dendritic cell 1st EXPOSURE Allergen SENSITIZATION PHASE ACTIVATION PHASE Late Phase Effects IL5 Eosinophil IL5 RE-EXPOSURE Modified from Kuby IMMUNOLOGY, Sixth Edition Vasoactive amines EFFECTOR PHASE A 30-year-old female complains of increasing prominence of the front of her neck. She admits to being nervous about many things lately and preferred to have the air-conditioner set at a very cool setting because she could not stand the heat. She however was happy about staying slender in spite of her hearty appetite. TSH determination showed a level below normal range. p. 201-204 What is the mechanism for the production of her condition: A. Defective apoptosis B. Autoantibody production C. Immune complex deposition D. Cell-mediated cytotoxicity E. Granuloma formation Graves’ Disease (pure type II) anti-TSH receptor autoantibodies cause thyroid epithelial cell hyperplasia and thyrotoxicosis A 10-year-old boy suffers recurrent bouts of Pneumocystis carinii pneumonia, Aspergillus fumigatus pneumonia, and parainfluenza virus and herpes simplex virus upper respiratory infections starting from the first year of life. A full term infant born by NSD, he developed tetany soon after birth. On PE the infant was noted to have a heart murmur. Serum calcium was low. Echocardiography showed VSD Which of the following abnormalities most likely explains the development of this infant's findings? A. Defect in NADPH oxidase B. Failure of maturation of B cells into plasma cells C. Reduction in number of CD4 lymphocytes D. A deficiency of adenosine deaminase E. Deficient T cell function Characteristic Facies in 22q11 syndrome Case 1 = Ate Kari & Diane (Diane, pakisend kay Kari. Di ko lam eadd niya. Thank you so much!) Case 2 = Miguel, Marlo, Topetiks, Ronald Case 3 = AJ, Pau, Abi Case 4 = Missy, Mel Case 5 = BJ, Cena