A 62 year-old male with end-stage renal disease expressed interest in receiving a renal transplant, and being taken to the operation theater for transplant surgery. The kidney is placed in the lower abdomen and blood supply is established with the iliac vessels. As the surgeons connect the donor kidney to the patient’s bladder, the patient’s temperature rose to 102 F, blood pressure dropped to 80/40 mmHg and heart rate has increased to 120 beats per minute. The transplanted kidney appears cyanotic, hemorrhagic, necrotic and mottled. What is the most likely diagnosis?
A 40 year-old woman presented to the dermatology clinic with frank, fluid filled, pruritic blisters on her forearms, hands, wrists, and legs. She reports that last week while working in her garden, she was exposed to poison ivy plants. You noticed vesicles and flaccid bullae in a linear configuration on the involved areas. Which of the following immunopathogenic mechanisms is most likely to be the cause of this skin disease?
A 46 year-old male developed a hard, painful swelling with redness and discoloration on his right shoulder. He reports 10 hours ago he received a tetanus vaccine on the site where it is hurting now. He reports that if his memory is right, his last tetanus vaccine was 3 years ago in the same site after he accidentally stepped on a nail. But he is not sure because he does not keep a record of his vaccinations. As you consider this reaction to the tetanus vaccine, what would be the best advice to give to this patient?
In Graves’ disease, the autoantibodies bind to the thyrotropin receptor on thyroid follicular cells resulting in the overproduction of thyroid hormones. Which one of the following four types of hypersensitivity reactions occur in this disease?
Hemolytic disease of the fetus is a condition where fetal red blood cells are destroyed due to blood group incompatibility, primarily involving Rh or ABO blood types. Which one of the following four types of hypersensitivity reactions occur in this disease?
A 34 year-old female was brought to the emergency room by her husband because she suddenly developed shortness of breath, swollen lips and face and severe itching all over her body. Forty minutes ago a bee stung her on the back while they were taking a walk in the park near their house. What is the most likely sequence of events that produced this hypersensitivity reaction?
A mother brings her 3 year-old son to the urgent care clinic. She reports that since this morning, her boy has developed a high fever, joint pains, itching, ankle swelling and erythematous plaques. He is otherwise playful and active. He was prescribed cefaclor 12 days ago by his pediatrician for an ear infection. She stopped cefaclor 2 days ago but wonders why the rash is not going away. On physical examination, the patient has a maculopapular rash on his trunk. Pharyngeal examination is normal. There are no mucosal lesions. He has submandibular lymphadenopathy. Heart and lung examinations are normal. Of the following, which is the most likely diagnosis?
A 22 year-old African immigrant male came to the emergency room reporting fever, chills, sweating at night, cough, pain in the chest, blood in the sputum and weight loss. His medical history is significant for AIDS and cryptococcal meningitis. He was diagnosed with HIV four years ago. Two months ago he was treated in this hospital for cryptococcal meningitis with IV infusions of amphotericin B and flucytosine. He improved well and was discharged in good condition. At the time of his discharge, his CD4+ cell count was 84 cells per microliter and HIV-1 viral load was 316232 RNA copies/mL. Two weeks after his discharge, he was started on highly active antiretroviral therapy (HAART) for HIV. He reports that he felt ‘great’ since his discharge from the hospital till this new sickness came up. His vital signs were, Temp = 101.2 F, O2 saturation 95%, BP 90/60 mm Hg, RR 17/minute, Pulse 94/minute. Some of the laboratory results are as follows: CD4 count is 1200 cells/mm3 HIV-1 viral load of 4800 RNA copies/mL Nucleic Acid Amplification Test is positive for mycobacterium tuberculosis in the sputum. Chest X ray showed bilateral lower lung zone infiltrates and mediastinal lymphadenopathy. On hearing these reports, the patient stated that while there are lots of people with tuberculosis in his native Senegal, he never thought he would get it. Which of the following was a risk factor for immune reconstitution inflammatory syndrome in this patient?
A 24 year-old male came to the emergency room complaining of fever, headache, nausea, vomiting, blurred vision, photophobia, lethargy, altered mental status and stiff neck. His past medical history is significant for HIV positivity and asthma. Physical examination revealed an irritable and restless patient with fever, altered mental status, stiff neck, nystagmus, papilledema, and cranial nerve deficits. Laboratory tests revealed elevated WBC with lymphocyte predominance, HIV-1 viral load of 302,551 RNA copies/mL and a CD4+ counts <100 cells/mm3. CSF culture came positive for cryptococcus antigen. Patient was diagnosed with cryptococcal meningitis and was started on amphotericin B and fluconazole. He showed good response to the treatment. His symptoms improved rapidly. Realizing that his life-threatening cryptococcal infection was due to his AIDS , he wanted to get started on highly reactive antiretroviral therapy (HAART) . Upon his discharge from the hospital, he was started on HAART. Two weeks passed uneventfully. Then, one evening, he returned to the emergency room complaining of fever, lymphadenitis, myalgia, cough, and chest pain. Physical examination is remarkable for lymphadenopathy, mucocutaneous ulcers in the mouth, bilateral rales on chest auscultation and hepatosplenomegaly. Vital signs: Temp: 100.6F, Oxygen Sat = 94, BP 100/70; Pulse = 97/min; RR = 22/min Some of the laboratory results are as follows: CD4 count is 800 cells/mm3 HIV-1 viral load of 4800 RNA copies/mL CSF positive for cryptococcus antigen Urine assay is positive for histoplasmosis Chest X ray showed apical infiltrates and nodules When the patient was told about his test results, he said he never heard about histoplasmosis and never had a sickness from it. After receiving treatment for cryptococcal meningitis, a HIV patient expressed interest to receive highly active antiretroviral therapy (HAART). Of the following, which describes the best way to reduce the risk of immune reconstitution syndrome in this patient?
A 24 year-old male came to the emergency room complaining of fever, headache, nausea, vomiting, blurred vision, photophobia, lethargy, altered mental status and stiff neck. His past medical history is significant for HIV positivity and asthma. Physical examination revealed an irritable and restless patient with fever, altered mental status, stiff neck, nystagmus, papilledema, and cranial nerve deficits. Laboratory tests revealed elevated WBC with lymphocyte predominance, HIV-1 viral load of 302,551 RNA copies/mL and a CD4+ counts <100 cells/mm3. CSF culture came positive for cryptococcus antigen. Patient was diagnosed with cryptococcal meningitis and was started on amphotericin B and fluconazole. He showed good response to the treatment. His symptoms improved rapidly. Realizing that his life-threatening cryptococcal infection was due to his AIDS , he wanted to get started on highly reactive antiretroviral therapy (HAART) . Upon his discharge from the hospital, he was started on HAART. Two weeks passed uneventfully. Then, one evening, he returned to the emergency room complaining of fever, lymphadenitis, myalgia, cough, and chest pain. Physical examination is remarkable for lymphadenopathy, mucocutaneous ulcers in the mouth, bilateral rales on chest auscultation and hepatosplenomegaly. Vital signs: Temp: 100.6F, Oxygen Sat = 94, BP 100/70; Pulse = 97/min; RR = 22/min Some of the laboratory results are as follows: CD4 count is 800 cells/mm3 HIV-1 viral load of 4800 RNA copies/mL CSF positive for cryptococcus antigen Urine assay is positive for histoplasmosis Chest X ray showed apical infiltrates and nodules When the patient was told about his test results, he said he never heard about histoplasmosis and never had a sickness from it. Of the following, which is a complication of IRIS in this patient?
