PBL Sessions: Immunologic Diseases

Page 6

Further History (Jack):

The issue regarding the lymphadenopathy has not been addressed. The nodes have not decreased in size and they remain non-tender. He is referred to a surgeon, with whom he argues regarding the cost of a biopsy. Jack negotiates a set price for outpatient surgery with local anesthesia. A cervical node biopsy is obtained. The biopsy findings are shown:

Figure 7: Microscopic appearance of the lymph node, low power

Figure 8: Microscopic appearance of the lymph node, high power

Figure 9: Microscopic appearance of the lymph node, immunohistochemical stain for CD20

Jack is referred to Dr. Oldham, who recommends biotherapy. Jack asks if he will have to stop working.

Further History (Madge):

She is prescribed corticosteroid therapy. She asks if this is a generic medicine and how much it costs and how long she will have to take it. She asks how the disease will be monitored. She improves on this therapy subjectively, with decreased malaise, and the rash goes away.

Tasks

• What do these findings indicate?

• What is the diagnosis from the microscopic images?

• What biotherapy agent would Dr. Oldham use, and how does it work?

• What hypotheses explain these findings?

• Explain the pathophysiologic mechanisms.

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