Lecture: Autoimmune diseases Flashcards
(41 cards)
1
Q
Phemphigus complex
A
- Autoimmune
- antibodies produced against demogleins
- causes acanthocytic cells
- type II hypersensitivity
2
Q
causes of pemphigus
A
- idiopathic
- drugs
- neoplasia
3
Q
Poster child for pemphigus foliaceous
A
- butterfly pattern appears on the face
- symmettrical
- periocular, bridge of nose
4
Q
P. foliaceous
A
- most common type
- dogs, cats, horses, goats
- middle aged animal
- target right below stratum corneum
- primary lesion: pustule (very transient) starts on face
- hyperkeratosis feet
5
Q
P. Folaceous in cats
A
- face
- ear pinnae
- nail bed
- peri-nipple
*Strippers dz (face, nails, boobs)
6
Q
DDX for PF
A
- Superficial pyoderma
- Dermatophytosis
- Demodicosis
- Seborrhea
- Sterile pustular dz
- SLE, MF
- Hepatocutaneous syndrome (NME)
7
Q
PF
DX
A
- BX an intact pustule if possible
- look for acantholytic cells inside the pustule
- they can be on antibiotics, but NOT STEROIDS
8
Q
Important points PF
A
- Rule out pyoderma and deomdex
- acantholytic cells
- immunosuppressive therapy contraindicated
- Make dx first: don’t attempt trial therapy
- waxing and waning dz
- long-term therapy can have serious side effects
9
Q
Therapy for P. foliaceus
A
- high doses of corticosteroids
- Azathioprine: dogs
- Chlorambucil: cats
- Gold
10
Q
Pemphigus erythematosus
about
A
- cross over between pemphigus and lupus
- milder than P. foliaceus
- antibodies
- intercellular spaces of epidermis (pemphigus)
- basement membrane zone (lupus)
11
Q
Clinical signs of P. erythematosus
A
- pustular dermatitis
- face
- ears
- nasal depigmentation
- aggravated by UV light
- no systemica signs
12
Q
P. erythematosus
DX
TX
A
- DX
- same as PF
- biopsy, but don’t do very often
- TX
- mild cases
- topical steroids or tacrolimus
- suncreen
- severe cases
- immunosuppressive therapy (same as PF)
- mild cases
13
Q
Pemphigus vulgaris
about
A
- rare in vet met
- most common type in humans
- acantholysis in lower epidermis: more severe lesions
14
Q
P. vulgaris
CS
A
- primary lesion is bulla
- ulcerations and erosions in mouth
- Animals are very ill
- lethargy
- fever
- anorexia
- common secondary infections
- bacterial
- yeast
15
Q
DDX for PV
A
- Drug eruption
- Antibiotics
- seizure meds
- Mycosis fungoides (cutaneous lymphoma)
- SLE
- bullous pemphigoid
- contact irritant
- Burn
- Candidiasis
16
Q
DX and TX PV
A
same as all the other pemphiguses
-biopsy areas that have just started, not ser. ulcerated
Prognosis is gaurded to poor
fatal without therapy
17
Q
Pemphigus vegetans
A
- very rare
- mild form of PV
- Proliferative lesions
- Scaling, crusting
- Axillae
- Groin
- DX and TX same as PF
18
Q
DIscoid Lupus Erythematosus
A
- face and nose
- aggravated by UV
- sunlight triggers new antigens
19
Q
Clinical signs of DLE
A
- Nose
- depigmentation
- loss of normal appearance
- erosions and ulcerations
- Pinnae
- Eyelids
- Lips
- Footpads (rare)
20
Q
DDX for depigmented/ulcerated nose
A
- Pemphigus
- Drug eruption
- Mycosis Fungoides
- VKH
- Irritant contact dermatitis
- Fungal infection
21
Q
DLE
DX
TX
A
- Diagnosis
- histopath if not on steroids
- TX
- topical steroids or tacrolimus
- sunscreens, vit. E
- systemic therapy
- steroids (low dose) or
- tetracycline/niacinamide
22
Q
systemic lupus erythematosus
A
- multisystemic disease
- antibodies produced against different antigens
- RBC
- Platelet
- Nuclear antigens
23
Q
Dermatological signs of SLE
A
- Seborrhea
- Vasculitis
- necrosis of pinnae and tip of tail
- footpads crusting and ulceration
- nasal depigmentation and ulceration
- mucocutaneous bullous dz
- panniculitis (lupus profundus)
24
Q
Lupus is a type ____ hypersensitivity
A
type III
(something about stuff getting stuck in small vessels)
25
DX of SLE
* take a biopsy
* baseline blood work
* ANA
26
SLE
Therapy
* Immunosuppressive drugs
* high doses steroids
* azathioprine
* chlorambucil
\*Gold is contraindicated due to nephrotoxicity
27
Bullous pemphigoid
* looks like PV without the acantholytic cells
* antibodies produced against basement membrane
28
BP
CS
* **primary lesion: bulla (very transient)**
* ulcerations
* fever, anorexia
* distribution
* oral cavity
* axillae and groin
* mucocutaneous junctions
* nail beds
29
BP
DX
* BX close to ulcer
* need epidermis (no epidermis in ulcer, I think)
30
Erythema Multiforme
* Immune mediated syndrome
* usually secondary to drugs or infections
* cephalosporins
* TMP-sulfa
* Levamisole
* Gold
* Acute, self-limited
* usually not systemically ill
31
Clinical signs of EM
* **Target lesions (bulls-eye)**
* Peripheral erythema and central clearing
* Macules
* Plaques
32
Erythema multiforme
DX
* DX
* History, CS, Histopath
* apoptotic cells
* lymphoplasmacytic interface infiltrate
* Therapy
* Id underlying cause
* supportive therapy: antibiotics for the secondary infection
* Steroids: controversial
33
Toxic Epidermal Necrolysis (TEN)
* Severe cutaneous eruption
* Systemically ill
* full thickness necrosis and sloughing
* Mucosal ulcerations
* Fever
* lethargy
* arthralgia
34
TEN
DX
* DX
* Histopath (early lesions)
* Full thickness necrosis
* TX
* ID underlying cause
* supportive care
* steroids **usually** contraindicated
* Prognosis
* poor (high mortality 80-90%)
* electrolyte loss
* secondary infections
35
Mycosis Fungoides (MF)
## Footnote
**cancer**
* Cutaneous lymphoma (T cell)
* Old animals
* various clinical pres
* erythema, pruritus and seborrhea
36
Mycosis Fungoides
CS
DX
* Depigmentation and ulcerations of mucous membranes and nose
* **bad breath**
* ****Gingivitis
* Stomatitis and oral ulcerations
* Plaques and nodules
* DX
* Biopsy
37
Necrolytic migratory erythema
* something about deficiency in amino acids
* nutritional therapy
* CS
* erythema, ulcerations and crusting
* pinnae
* muzzle
* footpads
* **lesions in genitalia are hallmarks**
* secondary bacterial and yeast infection
* usually borderline diabetic
38
NME
DX
* Histopath
* red-white-blue
* red: hyperkeratosis
* white: spongeosis
* blue: hyperplasia of basal layer
39
Not every crusty foot is....
PF
40
Therapy and prognosis for NME
* ID and correct, if underlying dz
* Tx secondary infections
* aminoacid (IV), zinc, fatty acid supplement
* egg yolk
* **no glucocorticoids**
* poor prognosis
41
Conclusions
* always treat secondary infections
* make lists of DDX for all problems
* correct dx important
* not everything that looks autoimmune needs steroids
* BX epidermis before steroids
