Autoimmune And Immune Mediated Dermatosis

Front 1

What is the mechanism involved with a Type II hypersensitivity reaction?

Back 1

IgG, IgM , Complement + target cell = Lysis and phagocytosis of cell

Front 2

What is the mechanism involved with a Type III hypersensitivity reaction?

Back 2

IgG, IgM , Complement + Ag => complexes trapped and attract PMN’s

Front 3

What is the mechanism involved with a Type IV hypersensitivity reaction?

Back 3

Cytotoxic action of activated lymphs

Front 4

What is the mechanism involved with a Type V hypersensitivity reaction?

Back 4

Ab stimulates cellular response

Front 5

What are some examples of Type II hypersensitivity reactions?

Back 5

-BP
-SLE
-DLE
-Drug

Front 6

What are some examples of Type III hypersensitivity reactions?

Back 6

-SLE
-DLE
-Drug
-Vasculitis

Front 7

What are some examples of Type IV hypersensitivity reactions?

Back 7

-Uveodermatologic Syndrome
-SLE
-Drugs

Front 8

What is the pathology of Pemphigus foliaceus?

Back 8

Pemphigus Ab => binding to pemphigus antigent (desmosome) on keratinocyte => internalization of pemphigus Ab =>activation and release of prteolytic enzymes (plasminogen activator) =>plasminogen converted into plasmin =>plasmin hydrolyzes cell adhesion molecules (desmosomes) =>Acantholysis (blister)

Front 9

What is the pathology of Pemphigus erythematosus?

Back 9

Pemphigus Ab => binding to pemphigus antigent (desmosome) on keratinocyte => internalization of pemphigus Ab =>activation and release of prteolytic enzymes (plasminogen activator) =>plasminogen converted into plasmin =>plasmin hydrolyzes cell adhesion molecules (desmosomes) =>Acantholysis (blister)

Front 10

What is the pathology of Pemphigus vulgaris?

Back 10

Pemphigus Ab => binding to pemphigus antigent (desmosome) on keratinocyte => internalization of pemphigus Ab =>activation and release of prteolytic enzymes (plasminogen activator) =>plasminogen converted into plasmin =>plasmin hydrolyzes cell adhesion molecules (desmosomes) =>Acantholysis (blister)

Front 11

What are the lesions associated with pemphigus folliaceus?

Back 11

Primary = transient pustule =>crust

Secondary =
-Alopecia
-Scale
-Erythema
-Erosions
-Nasal depigmentation
-Hyperkeratosis of pads
-+/- Pruritis
-Face and ear lesions
-Oral lesions are RARE
+/- Fever and anorexia

CAT:
-Crusting around nails
-Crusting-Alopecia
-Scale
-Erythema
-Erosions
-Nasal depigmentation
-Hyperkeratosis of pads
-+/- Pruritis
-Face and ear lesions
-Oral lesions are RARE
+/- Fever and anorexia

CAT:
-Crusting around nails
-Crusting around nipples around nipples

Front 12

What are the lesions associated with Pemphigus erythematosus?

Back 12

Primary lesions:
-Pustules to oozing crusts that ocsur on the face (ears, nasal region)
-Lesions can also be seen on the paws and genital regions
-Erythema
-Alopecia
-Erosions
-Nasal depigmentation
-Hyperkeratosis

Front 13

What are the lesions associated with Pemphigus vulgaris?

Back 13

-Vesiculobullous => erosive to ulcerative skin lesions +/- pruritis
-Oral and MC lesions are common
-Can also be seen in axillae, groin, clawbed, paw pad, concave pinna
-Fever
-Anorexia
-Depression
-Lymphadenopathy
-Pain

Front 14

What is the histopathology associated with pemphigus folliaceus?

Back 14

-Acantholytic cells w/ PMN +/-bacteria

-Subcorneal pustules w/ acantholytic cells +/- eosinophils

Front 15

What is the histopathology associated with Pemphigus erythematosus?

Back 15

-ANA may be positive
-Acantholytic cells may be present
-Subcorneal pustule +/- cellular infiltrate along the D-E junction

Front 16

What is the histopathology associated with Pemphigus vulgaris?

Back 16

-Suprabasilar acantholysis resulting in vesicle/cleft
-Basal cells appear as a row of tombstones
-+/- dermal infiltrates

Front 17

What is the pathogenesis of Bullous pemphigoid?

Back 17

Autoantibodies directed against self-antigens (hemidesmosomes) resulting in blistering just below the epidermis

Front 18

What is the clinical presentation of Bullous pemphigoid?

Back 18

-Clinically resemble Pemphigus vulgaris (PV) +/- photoaggrevation
-Vesiculobullous (tense) => erosive to ulcerative skin lesions +/- pruritis
-Oral MC lesions are common (no oral lesions in pigs)
-Axillea, groin, clawbed, paw pad, concave pinna, face
-Fever
-Anorexia
-Depression
-Lymphadenopathy
-Pain

Front 19

What is the histopathology associated with Bullous pemphigoid?

Back 19

-Subepidermal clefting + eosinophils in dog
-No acantholysis

Front 20

What is the pathogenesis of SLE?

Back 20

1.Type II hypersensitivity:
-Antibodies directed against self-nuclear antigens (DNA, RNA, histones)
2.Type III hypersensitivity:
-Antigen-antibody complexes lodged into vascular epithelium, synovium, muscle, skin BMZ
3.Type IV hypersensitivity:
-Cell-mediated activity against self-antigen

Front 21

What are some major signs of SLE?

Back 21

Skin lesions
Polyarthritis
Hemolytic anemia
Glomerulonephritis
Polymyositis
Leukopenia
Thrombocytopenia

Front 22

What are some minor signs of SLE?

Back 22

Fever of unknown origin
CNS signs
Oral ulceration
Lymphadenopathy
Pericarditis
Pleuritis

Front 23

What is needed to make a definitive diagnosis of SLE?

Back 23

2 Major and serology +
-OR-
major/2minor and serology +

Front 24

What is needed to make a probable diagnosis of SLE?

Back 24

1 major and serology +
-OR-
2 major and serology (-)

Front 25

What are some triggers of SLE

Back 25

-Genetics (loss of tolerance)
-UV light
-Hormones
-Infectious agents
-Drugs
-Chemical exposure

Front 26

What are some things found in Serology of a patient with SLE?

Back 26

ANA (high sensitivity)
Ab to nuclear material
LE (high specificity)
ID opsonized nuclear material in PMN and macrophages

Front 27

What are some differentials for nasal depigmentation?

Back 27

-Vitilligo (will not loose the normal cobblestone appearance of nose)
-Nasal depigmenation (snow nose and Dudley nose)
-Nasal solar dermatitis
-Contact dermatitis
-Uveodermatologic syndrome
-PF, PE, PV, BP, DLE, SLE
-Drug reaction
-Neoplasia

Front 28

What are some differentials for oral lesions?

Back 28

-DLE, SLE, PV, BP
-Erythema multiforme
-Vasculitis
-Drug reaction
-Neoplasia
-Candidiasis
-Eosinophillic granuloma
-Eosinophillic plaque
-Indolent ulcer
-Plasma cell stomatitis
-Gingival hypertrophy
-Erosions (chemical, viral, renal)
-Vegatative glossitis

Front 29

What class of drug is azathioprine (Immuran)?

Back 29

Anti-metabolite

Front 30

What class of drug is Chlorambucil (Leukeran)?

Back 30

Alkylating agent

Front 31

What immunosuppressive drug should not be used on cats?

Back 31

Azathioprine (Immuran)

Front 32

Should Chlorambucil (Leukeran) be used in cats?

Back 32

Yes, it is the primary choice for use in cats.

Front 33

What is the MOA of Azathioprine?

Back 33

Structural analog of natural metabolites that substitute for purines and pyrimidines

Front 34

What is the MOA of Chlorambucil (Leukeran)?

Back 34

Cross link DNA

Front 35

What is the MOA of Cyclophosphamide (Cytoxan)?

Back 35

Cross link DNA

Front 36

What is the MOA of Cyclosporine (Sandimmune and Neoral)?

Back 36

Inhibits Th cells early in the immune response w/ minimal effects on suppressor cells

Front 37

What are some side affects of Azathioprine?

Back 37

-Myelosuppression
-Hepatopathy
-GI effects

Front 38

What are some side affects of Chlorambucil (Leukeran)?

Back 38

-Myelsuppression
-GI effects

Front 39

What are some side affects of Cyclophasphamide (Cytoxan)?

Back 39

-Myelsuppression
-GI effects
-Sterile hemorrhagic cystitis

Front 40

What are some side affects of Cyclosporine (Sandimmune and Neoral)?

Back 40

-Myelsuppression
-GI effects
-Gingival hyperplasia
-Papillomatosis
-Nephrotoxicosis
-Lymphoma like lesions

Front 41

What are some side affects of Glucocorticoids?

Back 41

-PUPD
-Polyphagia
-GI ulceration
-Steroid hepatopahty
-Pancreatitis
-DM
-Muscle weakness
-Hypertension (+/- proteinuria)
-PTE (dyspnea)

Front 42

What is the general lesion distribution of pemphigus folliaceus?

Back 42

-Face, pinna, feet
-Perinipple and nails in cats

Front 43

What is the general lesion distribution of pemphigus erythematosus?

Back 43

-Nose and face

Front 44

What is the general lesion distribution of pemphigus vulgaris?

Back 44

-ORAL
-MC
-Nailbed
-Axillae
-Generalized skin

Front 45

What is the general lesion distribution of Bullous pemphigoid?

Back 45

-Oral (similar to PV)

Front 46

What is the general lesion distribution of DLE?

Back 46

-Nose and face

Front 47

What is the general lesion distribution of SLE?

Back 47

-Oral (localized or generalized)
-Footpads
-Sub Q nodules

Front 48

Are there systemic effects associated with SLE?

Back 48

Yes

Front 49

Are there systemic effects associated with PE?

Back 49

No

Front 50

Are there systemic effects associated with DLE?

Back 50

No