Case Study

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Akachi Chizoba presents to the Dermatology Clinic with an itchy rash on the trunk and extremities that started to appear 2 days after a camping trip to the Texas hill country.

The following images may help guide your discussion:

Skin with rash – Clinical presentation Links to an external site.

Skin, contact hypersensitivity lesion – Medium power Links to an external site.

Skin, early (preblister) contact hypersensitivity lesion – Medium power Links to an external site.

Skin, early (preblister) contact hypersensitivity lesion – Medium power Links to an external site.

Pathophysiology of contact hypersensitivity – Schematic Links to an external site.

Please choose at least two (2) of the following questions to answer in your initial post. Initial posts and responses must be based on and must include various resource references such as medical articles, and journals. Also, consider Medscape, Up-To-Date, and ePocrates as supplemental resources that are acceptable.  Must be published within the last 5 years.  Discussion posts must be in the correct 2020 APA 7th Edition Manual format for in-text citations and references.

  1. What is the epidemiology of skin rash/contact hypersensitivity? (CDC; WHO; other sources)
  2. What is the nature of the pathologic process occurring in this patient’s skin, and what is the likely etiology of this pathology?
  3. What is the primary leukocyte type responsible for this lesion?
  4. What factors are necessary for this cell type to cause this pathology?
  5. What is the Primary Diagnosis?  What are 2 possible differential diagnoses?  What is the likely outcome of this case?

 

Case Study 1.2 – Systemic Lupus Erythematous

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Victoria, a 44-year-old Vietnamese woman presented with complaints of fever for 2 weeks; pleuritic chest pain; and intermittent joint pain in her hands, feet, and knees. On examination, she was free of skin lesions. She had a pleural friction rub; a slightly swollen, tender right knee; and enlarged axillary, cervical, and inguinal lymph nodes. A chest film showed a small right pleural effusion; joint films were average except for a small amount of soft tissue swelling in the right knee. Hemoglobin was ten g/dL, and urinalysis revealed 4+ proteinuria with white blood cells, red blood cells, and red cell casts in the urine sediment. A VDRL test was positive. A test for antitreponemal antibodies was negative. Blood urea nitrogen (BUN) and creatinine were slightly elevated, and moderate hypoalbuminemia and hypergammaglobulinemia were present. An ANA test was positive at a titer of 1:2560 and was reported as showing a speckled pattern. A dsDNA antibody determination by the Crithidia luciliae assay was positive at 1:320, and an extractable nuclear antigen (ENA) antibody determination was reported as RNP (U1-RNP) and Sm antibody present. A C4 level was less than 10 mg/dL (reference range 12-45 mg/dL) and a C3 level was less than 40 mg/dL (reference range 88-192 mg/dL). The patient was treated with prednisone, 60 mg/day. After 4 weeks, the urine protein was 2+, the sediment had cleared, and BUN and serum creatinine had returned toward normal.

Consider the following images as you formulate your discussion posts:

Please answer the following questions based on the assigned TABLE to answer your initial post.

ALL STUDENTS WILL ANSWER QUESTIONS #1 & #8. Then, for your INITIAL POST, students with the LAST name beginning with the letter:

  • A – C | Will answer Questions 2
  • D – F | Will answer Questions 3
  • G – J | Will answer Questions 4
  • K – O | Will answer Questions 5
  • P – T | Will answer Questions 6
  • U – Z | Will answer Questions 7

Initial posts and responses must be based on various resources such as textbooks, peer-reviewed articles, and journals. Medscape, Up-to-Date, and ePocrates as supplemental resources are acceptable.

  1. What is the Epidemiology of SLE? Describe the cellular etiology – what’s happening at the cellular level?
  2. Considering the etiology of the symptoms in this disease, characterize what might be seen histopathologically in the skin.
  3. Why did this patient have a positive VDRL test?
  4. What are the major cells involved in the proliferative process?
  5. What is the inciting event leading to this proliferation?
  6. What is a typical clinical correlation to this?
  7. What is the significance of antinuclear antibody (ANA) tests in this patient?
  8. List two (2) possible differential diagnoses.

NB

My last name starts with “R”