Transcript CDSA: Immunopathology

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
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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
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4-6 days
T cell
2. Antigen processing
Blood vessel
3. T cell activation
4. Cytokine release
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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
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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
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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
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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
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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
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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
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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