Immunological diseases Kumar Flashcards

Question

**Erythema Multiforme** Treatment

Answer 1

❖Self‐limiting, resolves in a few weeks (It will go away on its own, you just have to manage symptomatically.) ❖Symptomatic management, IV rehydration, corticosteroids (topical and oral), antivirals in recurrent cases (We may use antivirals if they tell us they get cold sores every now and then this means they do have a history of herpes simplex.) ❖ Avoid causative drug (If drug‐related) ❖ Other second‐line systemic therapies (like cyclosporin, azathioprine and other serious drugs) ❖ Usually not life threatening unless in major form.

Answer 2

❖ 50% of cases precipitating cause is identified * Infectious Agents: Herpes simplex virus, Mycoplasma pneumonia, Adenovirus, Enterovirus, Coccidiomycosis * **Most of the time, erythema multiforme is related to a previous infection with herpes simplex virus.** * Drugs: Penicillin, Cephalosporins, Sulphonamides, NSAID’s, Phenytoin * Other: Foods (Benzoates, Nitrobenzene), Chemicals (Perfumes) ❖ it’s not an infection, it’s our body reacting to the infectious organism or pieces of it in a wrong way

Answer 3

**Granuloma** This is a granuloma. It’s composed of histeocytes that looks epithelioid. This is a collection of epithelioid histeocytes **Found in:** * TB (**They’ll be holding TB inside. But in TB you have caseous necrosis of granuloma.** * Deep fungal infections (**they holding? fungal organisms)** * GRANULOMATOUS DISEASES **( if with Asteroid bodies & Schaumann Bodies)** **In these granulomas we don’t know why they are forming.**

Answer 4

Orofacial Granulomatosis **Cheilitis granulomatosa=Involvement of lips alone** Non‐tender, persistent swelling NEED To BIOPSY to RULE OUT angioedema

Answer 5

**Orofacial Granulomatosis** Papules, slightly raised areas, fissures, cobblestone appearance **DDx** We could suspect a traumatic injury early signs of Crohn’s

Answer 6

Orofacial Granulomatosis

Answer 7

**❖ Idiopathic** **❖ Abnormal immune reaction** ❖ in orofacial granulomatosis, people form granulomas and it’s idiopathic ❖ we don’t know why they’re forming them so that’s an abnormal immune reaction.

Answer 8

❖ Discover cause ( we need to find out the cause.) ❖ Topical or intralesional corticosteroids (maybe try steroids) ❖ Other (topical tacrolimus, sulfazalazine, methotrexate, etc) ❖ Some cases resolve spontaneously *(This photo shows a person has puffiness because of granulomas. Sometimes it goes away on its own. We can use injection steroids on the lips too.)*

Answer 9

**Sarcoidosis‐Organ Systems** ❖ Lungs ❖ Lymph Nodes (bilateral hilar lymphadenopathy) ❖ Skin (25% of time) ❖ Eyes ❖ Salivary Glands ❖ Other (endocrine, gastrointestinal, heart, kidney, liver, nervous system, spleen, skeletal

Answer 10

Sarcoidosis‐Hilar Lymph Node Enlargement popcorn‐like calcifications in the hilar lymph nodes. granulomas from sarcoidosis being inside .

Answer 11

**Sarcoidosis**‐Skin Lesions **Lupus pernio** (nose, ears, lips and face) ‐ when we have these erythematous indurated, hard on face.

Answer 12

**Sarcoidosis** discrete clear granulomas. 2nd schaumann body in a giant cell (3rd to the right) Asteroid bodies ( right)

Answer 13

**Sarcoidosis** **DDX** in the oral cavity. It could be one of the three P’s: ❖ pyogenic granuloma ❖ peripheral ossifying fibroma ❖ peripheral giant cell granuloma.

Answer 14

❖ **Granulomatous disorder** ❖ Multisystem ❖ Unknown cause

Answer 15

Depends on the case! ❖ 60% of cases resolve within 2 years ❖ Initial diagnosis 3‐12 mo. observationàactive intervention as needed ❖ First line tx: corticosteroids ❖ Refractory dx: * Cytotoxic drugs (methotrexate, azithioprne) * TNF blockers * Hydroxychloroquine ❖ 4‐10% die of pulmonary, cardiac or CNS complications

Answer 16

**Granulomatosis with Polyangiitis** extra-oral Joint pain, weakness, tiredness ❖ Known as **Saddle nose deformity** ❖ First signs may be recurrent respiratory infection, cough or runny nose ❖ Oral lesions initial presentation in 2% of patients

Answer 17

**❖ This is Strawberry gingivitis** Granulomatosis with Polyangiitis "Wegener’s” Orally ❖ Ulceration, ❖ Mucosal nodules ❖ Facial paralysis ❖ Enlarged major gland from granulomas * we need to biopsy, as this also looks like a deep fungal infection. *

Answer 18

**Granulomatosis with Polyangiitis** Orally We want to biopsy to confirm because it Could be contact mucositis.

Answer 19

First line: oral prednisone ❖ After remission immunosuppressive drugs: ❖ Methotrexate ❖ Cyclosporine ❖ Rituximab ❖ Treatment induces prolonged remission ❖ May have relapses

Answer 20

**First line: oral prednisone** ❖ After remission immunosuppressive drugs: ❖ Methotrexate ❖ Cyclosporine ❖ Rituximab ❖ Treatment induces prolonged remission ❖ May have relapses

Answer 21

**‐ Cinnamon contact mucositis** This could be oral hairy leukoplakia. It could be hyperplastic candidiasis it could be tongue chewing it could be a leukoplakia. We’ll know what it is by biopsy and investigate

Answer 22

Urticaria.

Answer 23

Erythema multiforme

Answer 24

\* Erythema multiforme

Answer 25

**‐ Orofacial granulomatosis.** We make sure there’s no tb, no fungal, no foreign material in the granulomas

Answer 26

Sarcoidosis \*Erythemous papules (grey circle) Asteroid bodies ( blue arrow) Hilar lymph nodes (green circle)

Answer 27

Granulomatosis with polyangiitis

Answer 28

**orofacial granulomatosis.** What is the common way to describe this? **Cobblestone**. This is the classic cobblestone. Cobblestone and fissuring DDx: people with Crohn’s with oral manifestations it looks like this too.

Answer 29

**Sarcoidosis**

Answer 30

**Urticaria** developed after bites from an imported fire ant.

Answer 31

**Sarcoidosis** large red nodule on the lower lip.

Answer 32

**Erythema multiforme** multiple erosions on the lips and tongue.

Answer 33

**Erythema multiforme** The concentric erythematous pattern of the cutaneous lesions on the fingers resembles a target or bull’s-eye.

Answer 34

**Erythema Multiforme** Focal hemorrhagic crusting of the lips is seen in conjunction with diffuse shallow ulcerations and erosions involving this patient’s mandibular labial mucosa

Answer 35

angioedema

Answer 36

(Granulomatosis with polyangiitis) *formerly Wegener Granulomatosis.* Hyperplastic and hemorrhagic mucosa of the facial mandibular gingiva on the left side. ((strawberry gingivitis).