Ch. 9 Allergy/Immunologic, Part 1 Flashcards
Transient lingual papillitis other names
bumps, tongue torches
Local irritation, inflammation, hormones, stress, hypersensitivity cause a reaction of the ______ papillae in transient lingual papillitis
fungiform
3 clinical patterns of transient lingual papilitis
Localized
Generalized
Papulokeratotic
Most common location for localized transient lingual papillitis, the condition usually lasts for _____
anterior dorsal tongue
hours to days
Causative agent for:
localized TLP
generalized TLP
localized: maybe a food allergy
generalized: maybe viral as it is passed around families
Large % of the fungiform papillae located on the ______ tongue are affected in generalized TLP
tip and lateral dorsal
T/F papillae involved by papulokeratotic variant of TLP are symptomatic
false- asymptomatic
What causes the white appearance of the papulokeratotic variant of TLP
thickened parakeratotic cap
bacterial colonization
On average ____% of the population are affected by recurrent aphthous stomatitis
20%
ranges from 5-66%
Systemic disorders associated with recurrent aphthous stomatitis (11)
Behcet syndrome IgA deficiency Celiac disease Cyclic neutropenia Nutritional deficiencies IBD HIV and other immunocompromised Reactive arthritis -Sweet syndrome: very rare inflammatory skin condition characterized by a sudden onset of fever and painful rash on the arms, legs, trunk, face, or neck. -MAGIC syndrome: mouth and genital ulcers with inflamed cartilage -PFAPA syndrome: periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis Ulcus vulvae acutum
____% of patients with recurrent aphthous stomatitis have some underlying condition
60%
3 clinical variants of aphthous stomatitis and their alternative names
Minor aphthous (Mikulicz aphthae) Major aphthous (Sutton disease) Herpetiform aphthae
what % of aphthae are each type
80% minor
10% major
10% herpetiform
which type of aphthae are typically adult onset
herpetiform type
Simple vs complex aphthosis
Simple aphthosis: few lesions, heal in 1-2 weeks, recur infrequently
Complex aphthosis: 3 or more lesions, almost constant overlapping bouts of lesions; severe pain and large size are frequent
Behcet syndrome alternate names
Behcet disease, Adamantiades syndrome
classic triad of behcet syndrome
oral, genital and ocular inflammation
now we include systemic vasculitis
What genetic variation is associated with increased risk of Behcet syndrome
HLA-B51
frequent in japan, turkey, and eastern mediterranean
demographics of behcets
slight male predominance
3rd-4th decades
almost all behcet patients have oral ulcers. Most commonly what type?
Minor, but up to 40% have major type, and only 3% have herpetiform type
What % of behcet syndrome patients have genital ulcers?
75%
deep ulcers that tend to scar
T/F Blindness occurs in 25% of patients with ocular involvement of behcet disease
True
What % of patients with behcet disease have CNS involvement
10-25%
poor prognosis
International study group criteria for diagnosis of Behcet disease (no lab criteria)
Major criteria: oral aphthae
(2) Minor criteria: recurrent genital ulcers, eye lesions, skin lesions, positive pathergy test
What is a positive pathergy test? What is it used to diagnose
Stick a sterile 20 gauge needle into the skin, inject saline
One to two days later a sterile papule arises
*occurs in 60% of mediterranean behcets patients but only 3% of caucasians
- used to aid in the diagnosis of Behcets
what histologic pattern is seen in behcets ulcerations
leukocytoclastic vasculitis
Vessels show: intramural invasion by neutrophils, karyorrhexis(destructive fragmentation of the nucleus) of neutrophils, extravasation of red blood cells, and fibrinoid necrosis of the vessel wall
Demographics for sarcoidosis
black, female, before age 50
what % of patients with sarcoid are asymptomatic at diagnosis
20%
Predominant sites affected by sarcoidosis
lungs, lymph nodes, salivary glands, skin and eyes
*Mediastinal and paratracheal lymph nodes
What is a common radiographic sign of sarcoid of chest xray
bilateral hilar LAD
what are the indurated skin lesions of the nose,ears,lips and face in sarcoid?
lupus pernio
- Occurs in 25% of patients
- Frequent in head and neck region
What is a non-specific skin lesion often on the lower leg in sarcoidosis?
erythema nodosum
If sarcoidosis affects the lacrimal gland what condition can it mimic
keratoconjunctivitis sicca of sjogrens syndrome
What are the two clinical syndromes of Acute sarcoidosis
- Lofgren syndrome
2. Heerfordt syndrome
Features of Lofgren syndrome
- erythema nodosum
- bilateral hilar LAD
- arthralgia
Features of Heerfordt syndrome aka uveoparotid fever
- parotid enlargement
- anterior uveitis
- facial paralysis (ON THE BELLS PALSY DIFFERENTIAL)
- fever
In what % of patients are oral manifestations the first sign of sarcoidosis
2/3 66%
Are there intraosseous lesions of sarcoid?
yes- 1/4 of patients
3 Histologic buzzwords for sarcoid
- tight epithelioid GRANULOMAS
- Schaumann bodies: laminated basophilic calcifications within the granulomas
- Asteroid bodies: entrapped collagen within the granuloma
serum marker that can be elevated in sarcoidosis
60% of patients have elevated ACE
What WAS the skin test for sarcoid?
Kveim test (intradermal injection of sterilized suspension of sarcoid tissue)….Not done anymore
Helpful diagnostic aid which leads to diagnosis in 93% of patients
parotid biopsy
What % of patients have spontaneous resolution of sarcoidosis in 2 years
60%….10-20% of patients do not get resolution even with treatment…4-10% die of cardiac, respiratory, or CNS complications
Ocular involvment in sarcoid: 25% of the time and what is the clinical term (presentation)?
anterior uveitis
