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50 Cards in this Set

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What is the mechanism involved with a Type II hypersensitivity reaction?
IgG, IgM , Complement + target cell = Lysis and phagocytosis of cell
What is the mechanism involved with a Type III hypersensitivity reaction?
IgG, IgM , Complement + Ag => complexes trapped and attract PMN’s
What is the mechanism involved with a Type IV hypersensitivity reaction?
Cytotoxic action of activated lymphs
What is the mechanism involved with a Type V hypersensitivity reaction?
Ab stimulates cellular response
What are some examples of Type II hypersensitivity reactions?
-BP
-SLE
-DLE
-Drug
What are some examples of Type III hypersensitivity reactions?
-SLE
-DLE
-Drug
-Vasculitis
What are some examples of Type IV hypersensitivity reactions?
-Uveodermatologic Syndrome
-SLE
-Drugs
What is the pathology of Pemphigus foliaceus?
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)
What is the pathology of Pemphigus erythematosus?
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)
What is the pathology of Pemphigus vulgaris?
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)
What are the lesions associated with pemphigus folliaceus?
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
What are the lesions associated with Pemphigus erythematosus?
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
What are the lesions associated with Pemphigus vulgaris?
-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
What is the histopathology associated with pemphigus folliaceus?
-Acantholytic cells w/ PMN +/-bacteria

-Subcorneal pustules w/ acantholytic cells +/- eosinophils
What is the histopathology associated with Pemphigus erythematosus?
-ANA may be positive
-Acantholytic cells may be present
-Subcorneal pustule +/- cellular infiltrate along the D-E junction
What is the histopathology associated with Pemphigus vulgaris?
-Suprabasilar acantholysis resulting in vesicle/cleft
-Basal cells appear as a row of tombstones
-+/- dermal infiltrates
What is the pathogenesis of Bullous pemphigoid?
Autoantibodies directed against self-antigens (hemidesmosomes) resulting in blistering just below the epidermis
What is the clinical presentation of Bullous pemphigoid?
-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
What is the histopathology associated with Bullous pemphigoid?
-Subepidermal clefting + eosinophils in dog
-No acantholysis
What is the pathogenesis of SLE?
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
What are some major signs of SLE?
Skin lesions
Polyarthritis
Hemolytic anemia
Glomerulonephritis
Polymyositis
Leukopenia
Thrombocytopenia
What are some minor signs of SLE?
Fever of unknown origin
CNS signs
Oral ulceration
Lymphadenopathy
Pericarditis
Pleuritis
What is needed to make a definitive diagnosis of SLE?
2 Major and serology +
-OR-
major/2minor and serology +
What is needed to make a probable diagnosis of SLE?
1 major and serology +
-OR-
2 major and serology (-)
What are some triggers of SLE
-Genetics (loss of tolerance)
-UV light
-Hormones
-Infectious agents
-Drugs
-Chemical exposure
What are some things found in Serology of a patient with SLE?
ANA (high sensitivity)
Ab to nuclear material
LE (high specificity)
ID opsonized nuclear material in PMN and macrophages
What are some differentials for nasal depigmentation?
-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
What are some differentials for oral lesions?
-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
What class of drug is azathioprine (Immuran)?
Anti-metabolite
What class of drug is Chlorambucil (Leukeran)?
Alkylating agent
What immunosuppressive drug should not be used on cats?
Azathioprine (Immuran)
Should Chlorambucil (Leukeran) be used in cats?
Yes, it is the primary choice for use in cats.
What is the MOA of Azathioprine?
Structural analog of natural metabolites that substitute for purines and pyrimidines
What is the MOA of Chlorambucil (Leukeran)?
Cross link DNA
What is the MOA of Cyclophosphamide (Cytoxan)?
Cross link DNA
What is the MOA of Cyclosporine (Sandimmune and Neoral)?
Inhibits Th cells early in the immune response w/ minimal effects on suppressor cells
What are some side affects of Azathioprine?
-Myelosuppression
-Hepatopathy
-GI effects
What are some side affects of Chlorambucil (Leukeran)?
-Myelsuppression
-GI effects
What are some side affects of Cyclophasphamide (Cytoxan)?
-Myelsuppression
-GI effects
-Sterile hemorrhagic cystitis
What are some side affects of Cyclosporine (Sandimmune and Neoral)?
-Myelsuppression
-GI effects
-Gingival hyperplasia
-Papillomatosis
-Nephrotoxicosis
-Lymphoma like lesions
What are some side affects of Glucocorticoids?
-PUPD
-Polyphagia
-GI ulceration
-Steroid hepatopahty
-Pancreatitis
-DM
-Muscle weakness
-Hypertension (+/- proteinuria)
-PTE (dyspnea)
What is the general lesion distribution of pemphigus folliaceus?
-Face, pinna, feet
-Perinipple and nails in cats
What is the general lesion distribution of pemphigus erythematosus?
-Nose and face
What is the general lesion distribution of pemphigus vulgaris?
-ORAL
-MC
-Nailbed
-Axillae
-Generalized skin
What is the general lesion distribution of Bullous pemphigoid?
-Oral (similar to PV)
What is the general lesion distribution of DLE?
-Nose and face
What is the general lesion distribution of SLE?
-Oral (localized or generalized)
-Footpads
-Sub Q nodules
Are there systemic effects associated with SLE?
Yes
Are there systemic effects associated with PE?
No
Are there systemic effects associated with DLE?
No