Immunologic diseases Flashcards
Apthos Ulcers Etiology
The cause is unknown. There are many theories but all have yet to be substantiated.
There are 3 forms. Major, minor, and herpetiform apthos ulcers
They are painful, recurrent ulcers.
Ulcers are not preceded by vesicles, and usually occur in vestibular or bucal mucosa, tongue, soft palate, fauces, and floor of the mouth, very rarely in attached gingiva (except in AIDS patients)
Minor Apthos Ulcer
Usually appear as a single, apinful oval ulcer less than 0.5cm in diameter, coverd by a fibrinous membrane and surrounded by erythematous halo.
HTey generally last 7-10 days and heal without scar fomation.
Major Apthos Ulcers
Apthos lesions that are larger than 0.5cm. THey are more painful and persist longer than minor lesions. They can take as long as 6 weeks to heal, and often reform as soon as one dissapears.
Herpetiform Apthos Ulcers
appear clincically as recurrent crops of small ulcers. These are not preceeded by vessicles, and exhibit no virus-infected cells.
Apthos Ulcers Differential
Secondary Oral Herpes (usually have vessicles preceeding, and are located on the gingiva/hard palate)
Trauma
Pemphigus Vulgaris
Mucous Membrane Pemphigoid
Neutropenia
Apthos Ulcer treatment
Treatment is usually not necessary, but corticosteroids, topical or systemic can be used if needed.
Chronic Ulcerative stomatitis
Can resemble hypersensitivity reaction, licken planus, mucous membrane pemphigoid, linear immunoglobulin A disease, and pemphigus vulgaris
Direct immunofluorescence examination shows perinuclear deposits of IgG
Erythema Multiforme Etiology
An acute, self limiting, hypersensitivity reaction characterized by target skin lesions and ulcerative oral lesions.
Suspected to be a hypersensitivity reaction. Triggering events can be identified in about half of cases, such as drugs (barbiturates, sulfonamides, and some anti-seizure medications)
Typically characterized as an ulcerative disease, wiht short lived vesicles seen occasionally. Extreme forms are known as stevens-Johnson Syndrome, usually are medication related, and can show crusting ulceration in the vermilion border.
Erythema Multiforme Histopathology
Epithelial hyperplasia and spongiosis. Epithelial necrosis is common, infiltrated connective tissue with lymphocutes and macrophages.
Erythema Multiforme Differnetial
Diagnosis is usually straightforward when target or iris skin lesions are present diagnosis is straight forward.
primary HSF
Apthos Ulcers
Pemphigus vulgaris
mucous membrane pemphigoid
paraneoplastic pemphigus
Erosive Lichen Planus
Erythema Multiforme treatment
Minor, asymptomatic treatment may be all that is necessary, bland mouth rinse etc
In EM major topical corticosteroids with antifungal may help control disease. Systemic corticosteroids is controvertial.
Drug Reactions etiology
Can range from a blistering, lichenoid reaction and lupus-like reactions, ulcerative lesions, and fixed eruptions.
Typicaly IgE mediated reactions, cototoxic reactions, and circulation of angigen-antibody complexes
It can appear as an anaphylactic reaction, or more of a rash/erythemia/vessicle/uceration reaction.
Drug reaction histopathology
non-specific features such as spontiosis, apoptotic keratinocytes, lymphoid infiltrates, eosinophils, and ulceration
Drug reaction diagnosis
The diagnosis is a high index of suspicion and careful history taking. Recent drug/medication use is necessary, and elimination should resolve symptoms.
Contact Allergies Etiology
They occur directly adjacent to the causatie agent. Can be ulcerative, erythematous, vesicular, lichenoid, lesions/
Contact allergies Histopathology
Microscopically the epithelium and CT show inflammatory changes. Spongiosis nad vesiculation ma be seen
Contact Allergies Diagnosis
careful history taking is essential. Biopsy findings may be confirmatory. Treatment is elimination of the offending material.
Wegeners Granulomatosis etiology
inflammatory necrotizing vasculitis with unknown cause. 90% of cases are in caucasian.
Frewuently a painful cobblestone mucosal alteration.
Wegeners Granulomatosis histopathology
characteriscic necrotizing vasculitis. Necrosis and multinucleated giant cells may be seen in granulomatous areas.
Wegeners Granulomatosis Diagnosis
usually the finding of granulomatous inflammation and necrotizing vasculitis in biopsy.
Wegeners Granulomatosis treatment
cytotoxic agent cyclophosphamide with corticosteroid has proven to be an effective treatment.
Midline Granuloma Etiology
usually a diagnosis of exclusion of the granulomatous and necrotizing midfacial lesions.
They are unifocal destructive and aggressive lesions in the midline of the oronasal lesion.
Midline Granuloma Histopathology
acute and chronic inflammation wiht partially necrotic tissue
Antiocentric inflammation is a common finding, and typical of many lymphomas
Midline Granuloma treatment
Local radiation can work in limited disease cases. In advanced cases chemotherapy may be needed too.
