Question

45-year-old man with a history of IV drug use presented to the emergency room complaining of a rash and fever.The patient also complained of a several-day history of malaise, fatigue, headaches, and a sore throat.

Physical examination revealed a moderately ill-appearing man with a temperature of 38.8°C (102°F). He had a blanching erythematous, macular-papular rash evident over the trunk, back, and upper and lower extremities. In addition, his throat showed enlarged tonsils and broad-based ulcerations on the buccal mucosa.

He had a history of an episode of endocarditis 2 years ago. At that time, an HIV serology test was performed. It was negative.

Laboratory Data

A CBC and liver function tests were ordered. Results showed that the patient is anemic (hematocrit, 38%). He also had a severely decreased total leukocyte count and a severely decreased absolute lymphocyte count. Some of his liver function test results were abnormal.

Group Discussion Questions

1. What is a likely diagnosis of this patient’s condition?

2. What is the natural history of this disease ( stages of the disease) ?

3. What immunologic laboratory tests might be of value in establishing a diagnosis for this patient?

Case 2

History and Physical Examination

A 21 year-old college student presented to the Student Health Services complaining of a slowly developing rash on both earlobes, hands and wrist, and around her neck.

Her medical history revealed that she had eczema in childhood. During her early teens, she had facial acne, for which she was given tetracycline.

Physical examination revealed a rash of erythema and small blisters, with marked excoriation because of the itching. Her hands were red, scaly, and dry. The rash on her hands was different from the eruptions on her neck and ears. A contact hypersensitivity was suspected.

Follow-up patch tests included a standard battery of agents—rubber, cosmetics, plant extracts, perfumes, nickel, and makeup. Strongly positive reactions for rubber and nickel were observed.

The student was advised to eliminate contact with rubber (e.g., rubber gloves) used at home or on the job. Her jewelry probably contained nickel and was believed to be the source of the irritation to her earlobes, neck, and wrists. She was advised to wear only nickel-free jewelry. A mild corticosteroid cream was prescribed for use until her symptoms disappeared.

Questions:

1. What type of hypersensitive reaction is this?
2. Why did the jewelry cause a rash?

Answer 1

Type of hypersensitivity reaction:type 4 hypersensitivity reaction.

delayed hypersensitivity:

CO allergic reaction:-(elayed Hyper sensitivito * Most alleagic reaction, wicke & Earring can cause Iflammation and swelling of some kind of Jewellery, can cause one on both Earlobes to swell & Removing The Earring, choose to wear without Nickell,

Jewelry causes rash:

Nickel I contact * an itch usually * Earning Miekel alleagy is common cause of allergic dermatitis, rash appeaus where your skin touches harmless Swostance make your earlobes itch allergic to