AUTOIMMUNITY-I,II, III
PRACTICAL 4
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Case No 1
A 25-year-old woman has had increasing malaise,
a skin rash of her face exacerbated by sunlight
exposure, arthralgias and myalgias for the past
month.
On physical examination she has mild leg edema.
On auscultation, a friction rub is audible over the
chest.
Laboratory findings include
pancytopenia and serum creatinine 3 mg/dL.
Urinalysis shows hematuria and proteinuria.
Serologic test for Auto-antibodies.
A renal biopsy shows granular deposits of IgG
and complement in the mesangium &BM.
Malar rash butter-fly (rash on cheeks)
Discoid rash
Lupus nephritis :a glomerulus with several "wire loop"
lesions representing extensive subendothelial deposits of
immune complexes
SLE- skin lesion show vacuolar interface
dermatitis with deposition of IgG in BM
Sterile non-infective vegetations, called LibmanSacks endocarditis, are on BOTH sides of the leaflet.
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Questions
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Which mechanisms is most likely involved in the
pathogenesis of her disease?
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How to establish the Diagnosis?
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Write the suitable laboratory diagnosis to reach
the diagnosis?
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Mention the signs of severity in previous case?
How to establish the Diagnosis
History: characteristic symptoms
 Classical physical findings and signs
 I)Skin-Malar rashes(erythematous)+ Discoid
rashes (scaly)
 2) Arthritis,
 3)photo-sensitivity.
 SLE is summarized in “SOAP BRAIN MD”
Four out of eleven of : (S=serositis, O=oral
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ulcers, A=arthritis, P=photosensitivity, pulmonary
fibrosis, B=blood cells, R=renal, Raynauds,
A=ANA, I=immunologic (anti-Sm, anti-dsDNA),
N=neuropsych, M=malar rash, D=discoid rash),
Name of test
Name of test
Urine analysis
skin biopsy & IF
CBC+PBF
Renal biopsy & IF
ESR, CRP,
LE-cells test
RFT, LFT
Imaging studies
Auto-antibody type
ANA
Anti ds DNA
ANTI-sm
Anti-phospholipid
Target components
Nuclei
Nuclear genome
Nuclear protein
Cell Phospholipid
RF
The lupus erythematosus (LE) cell test- is a
diagnostic test of SLE
LE cell is a neutrophil or macrophage that has
phagocytized (engulfed) the denatured nuclear material
of another cell.
 Case
No -2
 A 57-year-old woman has had increasing
pain and deformities in her hands for the
past 10 years. On physical examination,
she has bilateral ulnar deviation and
swan-neck deformities of several fingers.
 There is a subcutaneous nodule on the
ulnar aspect of the right forearm.
 A biopsy specimen of the nodule sent
for histopathology?
Sub-cutaneous nodule
RA- narrowing of joint space and marginal erosions on
both radial& Ulnar + dislocation
RA: synovial hypertrophy with formation of villi,
subsynovial tissue containing a dense lymphoid aggregate
Pannus=Subcutaneous rheumatoid nodule with an
area of fibrinoid necrosis (top) surrounded by a palisade of
macrophages& scattered chronic inflammatory cells
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Questions

Which mechanisms is most likely involved in the
pathogenesis of her disease?
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How to establish the Diagnosis?

Write the suitable laboratory diagnosis to reach
the diagnosis?
How to establish the Diagnosis
History: characteristic symptoms
 Classical physical findings and signs
 I) Articular symptoms& signs: symmetrical joints
(> three), deformities, morning stiffness,
Arthritis,
 2) Muscular atrophy- bone erosion- articular
cartilage surface damaged.- synovitisthickening- fibrosis- calcification.
 3) Sub-cutaneous nodules
 4) systemic – fever, fatigue, vascuiltis, heart, ,
etc..
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Name of test
Urine analysis
CBC+PBF
ESR, CRP,
RFT, LFT+ Imaging study of joint and bone
Auto-antibody type
RF
Anti-CCP (cyclic citrullinated
peptide)
HLA
Non-HLA
 Case
No 3
A 45-year-old woman has had a burning
sensation with increasing blurring of vision for
the past 5 years as well as persistent difficulty
in swallowing.
 On physical examination, she has
keratoconjunctivitis. Atrophy of the oral
mucosa, with buccal mucosal ulcerations,
also is present.
 A biopsy specimen of the lip shows marked
lymphocytic and plasma cell infiltrates in minor
salivary glands.
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 Questions
 Which
of the following antibodies is
most likely to be identified on
laboratory testing?
 ANA, RF, Anti SS-B (La), Anti SS A (R0)
 How
to establish the Diagnosis?
 Write
the suitable laboratory diagnosis
to reach the diagnosis?
Name of test
Urine analysis
CBC+PBF
ESR, CRP,
RFT, LFT+ Imaging study of joint and bone
Auto-antibody type
Anti SSa\R0= target nucleic acids in cytoplasm
Anti-SSb (La)=protein b\w nuclei&cytoplasm
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ANA= nucleic acid in nuclei+ HLA- DR3, etc
Thanks