PBL Sessions: Immunologic Diseases


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Page 5

History of Present Illness:

Madge comes to see you a month later with a history of increasing fatigue and aches and pains in her extremities over the past 5 months.

Physical Examination (Madge): She is afebrile. Her blood pressure is 160/100 mm Hg. Her heart rate is 82/min without murmurs, but there is an audible friction rub. Her lungs are clear but there is dullness to percussion at posterior lung bases. Her abdomen is soft and non-tender, with normal bowel sounds. Her stool guaiac is negative. Pelvic examination is normal. There are no abnormal neurologic findings. There is erythema of her face, neck, and forearms.

A chest x-ray shows bilateral pleural effusions.

Laboratory findings (Madge):

Serum chemistries show sodium 139 mmol/L, potassium 4.0 mmol/L, chloride 101 mmol/L, CO2 25 mmol/L, creatinine 2.7 mg/dL, and glucose 77 mg/dL.

CBC with Hgb 11.7 g/dL, Hct 35%, MCV 86 fL, WBC count 3820/microliter with differential count 74 segs, 1 band, 18 lymphs, 7 monos, and 2 NRBCs/100 WBCs, and platelet count 92,280/microliter.

Prothrombin time 12 seconds (control 12.1 seconds) and partial thromboplastin time 26 seconds (control 25.5 seconds).

Shown in the image is the representative microscopic appearance of her kidney.

Figure 4: Kidney

Shown in the image is the representative microscopic appearance of her peripheral blood smear.

Figure 5: Peripheral blood smear

Shown in the image is the representative microscopic appearance of her skin.

Figure 6: Skin (immunofluorescence)

Tasks

  • What do these findings indicate?

  • What hypotheses explain these findings?

  • Explain your reasoning for the hypotheses you choose.

  • Explain the pathophysiologic mechanisms.

  • Is there anything that can tie these findings together?

    Stop !! Complete discussions and tasks before moving to the next page.