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SITUATIONAL ANALYSIS

TISSUE REACTIONS TO INJURY


Part 3: Immune Reactions to Injury

Principles of Infectious Disease, Autoimmune


Disease, and Immune Deficiencies

Prepared by
EMMANUEL R. de la FUENTE, M.D.
Objectives
2. To recognize the patterns of inflammation
in the different types of infectious disease
3. To discuss the essential mechanisms of
important autoimmune, primary and
acquired immunodeficiency diseases
4. To state the essential morphologic features
of the above (no. 2)
Principles of Infectious Disease
Different types of infectious disease give different
patterns of inflammation and necrosis. These
patterns are:
2. Acute inflammation with liquefactive necrosis
(pyogenic inflammation)
3. Acute inflammation with coagulative necrosis
(which may become purulent later on)
4. Granulomas with or without caseous necrosis
5. Predominantly lymphohistiocytic inflammatory
response
Situation No. 1
A 14 year old boy was admitted to a hospital
because of dyspnea. Crackles were heard on all
lung fields. These were accompanied by fever and
cough.
Antibiotics were given but his condition worsened;
he died four days after admission.
1. State the problem of this case.
2. What are the facts that support your
problem statement?
3. Give hypotheses as possible explanations
to the problem.
The next set of microscopic pictures shows
the different stages of development of the
lesions not in chronological order.
Slide no. 1. Identify and describe the lesion.
What phase of acute inflammation is seen?
Slide no. 2. Identify and describe the lesion.
What phase of acute inflammation is seen?
Slide no. 3. Identify and describe the lesion.
What pattern of inflammation and necrosis is
seen?
Slide no. 4. Identify and describe the lesion. What
pattern of inflammation and necrosis is seen?
1. Arrange now the previous slides into
their sequence of development.
2. What biological characteristics do these
organisms have that give rise to this
pattern of inflammation and necrosis?
3. Correlate these lesions with the clinical
situation (final hypothesis).
Identify and describe the gross lesions and correlate
with the microscopic lesions.
Situation No. 2
A 67 year old woman who had been diabetic for the
past 30 years had persistent fever for the past 3
wks. This was accompanied by chronic cough and
difficulty of breathing. The attending physician had
suspected pneumonia, and she was given
antibacterial chemotherapy which afforded no relief.
Sputum culture showed filamentous fungal
elements. After a week her pulmonary
manifestations became more severe, and further,
she developed weakness of the left upper and lower
extremities. She died shortly thereafter.
1. State the problem of this case.
2. What are the facts that support your
problem statement?
3. Give hypotheses as possible explanations
to the problem.
Filamentous fungal elements seen in sputum culture.
This is a silver stain of an arteriole of the brain which
stains the fungal elements. Similar lesions are seen in
other organs. Identify the organism and predict the
consequences.
The lung. Identify and
describe the lesion.
What type of necrosis do
you expect to see?
Discuss the pathogenesis
of the lesion.
A section of the brain. Identify and describe the
lesion. What type of necrosis do you expect to
see? Discuss the pathogenesis of the lesion.
1. What type of immune response do you
expect to see in this type of infection?
2. Explain why?
3. Correlate these lesions with the clinical
situation (final hypothesis).
Situation No. 3
Patient no. 1 is a 3 year old girl who developed
signs and symptoms of measles. Four days later,
she developed severe dyspnea and died.
Patient no. 2 is a neighbor of similar age who also
developed measles at approximately the same
time. She, however, became well after a week.
1. State the problem of this situation.
2. What are the facts that support your
problem statement?
3. Give hypotheses as possible explanations
to the problem.
This is a section of the lung of that girl who died.
Identify and describe the lesion.
Most areas of the lung show this lesion. Identify
and describe the lesion. Identify the lesion in the
inset and the structure indicated by the arrow.
1. Discuss the immune response seen in the lung
sections.
2. Give possible reasons why numerous giant cells
with inclusion bodies are formed.
3. Is this infection caused by a DNA or RNA virus?
4. Give possible explanations why patient no. 1
despite the presence of an immune response
died while patient no. 2 lived.
Immune Deficiencies
Review the history and immune responses of the 3
previous cases. If the failure of the immune
response to neutralize and/or destroy the infectious
agent is due to some immune deficiencies, discuss
the possible areas of failure of the immune system.
Autoimmune Disease
2.Organ-specific
3.Systemic
Situation No. 1
A 48 year old woman was diagnosed to have Hashimoto’s
Disease of the thyroid. Which of the two gross thyroids is
consistent with the diagnosis? Describe and explain the gross.

1 cm 1 cm
Microscopic sections. Identify and describe the lesion. What
type of immune response is represented by this type of
morphology? Explain.

40 x 400 x
Situation No. 2
An 18 year old girl
developed erythematous
rashes all over her skin.
She was diagnosed as a
case of lupus
erythematosus.
Characteristic “butter”
rash was seen on her
face. A biopsy of her
skin lesion was done.
Sections of the skin. Identify and describe the lesion. The
arrow indicates an arteriole. Discuss the immune response as
manifested by this morphologic pattern.
An immunofluorescence stain with antibody to complement
shows the brightly fluorescing band along the dermal
epidermal junction (arrow). This indicates the presence of
immune complex deposits. Explain this phenomenon.
Transplantation Pathology
Situation No. 1
An allograft transplanted heart rejected by the host.
Identify and describe the lesion. Discuss the immune
response.
Situation No. 2
An allograft transplanted kidney rejected by the host.
Identify and describe the lesion. Discuss the immune
response.
The End