Emily Stӓke
Case Study Homework 1
Differential Diagnosis and Treatment of an Immune Response
ANSWERS to Part 1 – The Investigative Process
1.)The pain that Jamie describes in her hands, making it difficult for her to pipette, would lead the
physician to suspect a systemic disease. The hands of the body, which consist of various tissue types,
including blood vessels, nerves, skin and skin-related tissues, bones, muscles, tendons and
ligaments, may show signs that reflect a disease that affects other parts of, or even the whole body
(systemic diseases). Add this to Jamie’s description of her knees and elbows aching as well, is
enough for the doctor to suspect a systemic illness.
The chronic fatigue/lack of stamina/feeling run down that Jamie has been experiencing may lead the
physician to suspect a systemic disease. Along with the information Jamie provided about her family
history, that her maternal grandmother suffered from rheumatism, also would lead the physician to
suspect this.
The frequent cold sores, which Jamie has been treating with over-the-counter medication, are a
symptom of Lupus, which is systemic.
Also, the doctor finds a rash on Jamie’s upper back where she is typically exposed to the sun. Skin signs
of systemic diseases occur frequently, and sometimes feature the first symptoms of a systemic disease.
Jaimie’s blood pressure is also slightly elevated, and hypertension/high blood pressure can be an
indicator of something systemic.
2.) Autoimmune Disease = A condition in which your immune system mistakenly attacks your own body.
Autoantibody = An antibody produced by the immune system that is directed against one or more of
the individual's own tissues and proteins. Many autoimmune diseases are caused by these
autoantibodies. 3.) Environmental triggers associated with Autoimmune Diseases: Climate, stress,
occupation, chemicals, genetics, cigarette smoking, and diet. Growing evidence suggests that
particularly a typical ‘Western diet’, rich in saturated fat and salt and related pathologies can have a
profound impact on local and systemic immune responses. Shifts and reduction in gut microbiota are
tightly connected to the immune system, immune regulatory processes, and autoimmune diseases.
Many autoimmune diseases involve environmental factors that act on top of genetic susceptibility.
4.) Some Autoimmune Diseases include: Systemic Lupus Erythematous, SLE, Sjögren’s syndrome,
Raynaud’s Syndrome, Rheumatoid Arthritis, Multiple Sclerosis, Psoriasis, Grave’s Disease, Hashimoto’s
Thyroiditis, Celiac Disease, Crohn’s Disease, Psoriatic Arthritis, Antiphospholipid Syndrome, and
Scleroderma.
5.) Some typical signs and symptoms of Autoimmune Disease (using Lupus as an example) are: achy
joints (arthralgia), unexplained fever (more than 100 F), swollen painful joints (arthritis), prolonged or
extreme fatigue, skin rash, ankle swelling and fluid accumulation, pain in the chest when breathing
deeply (pleurisy), a butterfly-shaped rash across the cheeks and nose, hair loss, sensitivity to the sun
and/or other light, seizures, mouth or nose sores, and pale/purple finger or toes from cold or stress
(Raynaud’s Syndrome).
6.) Criteria for the diagnosis of:
Systemic Lupus Erythematous (SLE) = Malar rash or skin rash, photosensitivity- unusually strong
reaction to sun light, causing a rash or flare, mouth or nose ulcers, inflammation in two or more joints,
inflammation of the heart lining and/or lungs, neurologic disorder like seizures and/or psychosis, kidney
disorder – increased protein or clumps of red cells in urine, blood disorder – anemia caused by
damaged
\
, red cells, low white cells or low platelet count, immunological disorder – when your immune system
attacks healthy cells, and antinuclear antibodies (ANA) – positive blood test not induced by drugs.
Rheumatoid Arthritis = Rheumatoid arthritis can be difficult to diagnose because the early signs and
symptoms mimic those of many other diseases. There is no one blood test or physical finding to
confirm the diagnosis. However, in blood tests, people with rheumatoid arthritis often have an
elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), which may indicate the
presence of an inflammatory process in the body. Symptoms that begin the diagnosis process include:
Joint pain, chronic stiffness and swelling, swelling affecting 3-4 different joints or more, morning
stiffness, swelling and pain affecting the wrists, hands and finger joints, and Rheumatoid nodules
developing under the skin.
Lyme Disease = A blood test for antibodies to the bacteria is the preferred test for the diagnosis of Lyme
disease. Signs and symptoms of Lyme disease may include: A characteristic "bulls-eye" rash that spreads
from the site of the bite, fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes.
Chronic Epstein Barr Syndrome = It is hard to tell whether or not you have Epstein Barr just by your
symptoms since they are so generic. The proposed diagnostic criteria included the following: 1)
persistent or recurrent infectious mononucleosis-like symptoms; 2) an unusual pattern of EBV
antibodies with elevated anti-VCA and anti-EA, or detection of the EBV genome in affected tissues
including the peripheral blood; and 3) chronic illness that cannot be pinpointed 4) An enlarged spleen
and tonsils
7.) The doctor suspects that Jamie may be anemic because due to the fatigue she is experiencing along
with Jamie’s overall weakness/Lack of stamina. Her slightly elevated heartbeat is also a symptom of
anemia.
ANSWERS to Part 2 – Understanding Results
1.) Abnormal test results include: All CBC lab test results are lower than the average reference range for
women (WBC count, RBC count, Hemoglobin, Hematocrit and Platelet count. ESR (Sedimentation Rate)
is very elevated at 61mm/hr. Iron (Chem Panel Lab Test) is elevated at 189 ug/dL. Immunology Lab Tests
for C-Reactive Protein is inflated at 5.8 mg/L, and VDRL’s are Positive along with Positive ANA’s, which
should both be Negative- indicating abnormal test results.
2.) CBC Lab Test Results: A low WBC count (leukopenia) may be caused by a medical condition, such as
an autoimmune disorder that destroys white blood cells. A low RBC count, a low Hemoglobin, and a
low Hematocrit result indicates anemia. Anemia has many causes, including low levels of certain
vitamins or iron, blood loss, or an underlying condition. However, Jaimie’s Iron count (from her Chem
Panel Results) is elevated- it is NOT low. Therefore, anemia is ruled out and an underlying condition
such as an autoimmune disorder, as mentioned above, is way more likely. Lastly, a platelet count that's
lower than normal (thrombocytopenia) is often a sign of an underlying medical condition as well.
ESR (Sedimentation Rate): Erythrocyte sedimentation rate is a test that indirectly measures the degree
of inflammation present in the body. Inflammation is part of the body's immune response. It can be
acute, developing rapidly after trauma, injury or infection, or can occur over an extended time (chronic)
with conditions such as autoimmune diseases. Considering the fact that Jamie’s ESR Rate is so high, a
chronic and systemic autoimmune disorder is suspected.
Iron (Chem Panel) Test Results: Jamie’s Iron results were high. A condition called Hemochromatosis
causes your body to absorb too much iron from the food you eat. Excess iron is stored in your organs,
especially your liver, heart and pancreas. Too much iron can lead to life-threatening conditions such as
liver disease and heart problems. Some symptoms of this include joint pain, fatigue and overall weakness
which also happen to be signs and symptoms of autoimmune disease.
\
Case Study Homework 1
Differential Diagnosis and Treatment of an Immune Response
ANSWERS to Part 1 – The Investigative Process
1.)The pain that Jamie describes in her hands, making it difficult for her to pipette, would lead the
physician to suspect a systemic disease. The hands of the body, which consist of various tissue types,
including blood vessels, nerves, skin and skin-related tissues, bones, muscles, tendons and
ligaments, may show signs that reflect a disease that affects other parts of, or even the whole body
(systemic diseases). Add this to Jamie’s description of her knees and elbows aching as well, is
enough for the doctor to suspect a systemic illness.
The chronic fatigue/lack of stamina/feeling run down that Jamie has been experiencing may lead the
physician to suspect a systemic disease. Along with the information Jamie provided about her family
history, that her maternal grandmother suffered from rheumatism, also would lead the physician to
suspect this.
The frequent cold sores, which Jamie has been treating with over-the-counter medication, are a
symptom of Lupus, which is systemic.
Also, the doctor finds a rash on Jamie’s upper back where she is typically exposed to the sun. Skin signs
of systemic diseases occur frequently, and sometimes feature the first symptoms of a systemic disease.
Jaimie’s blood pressure is also slightly elevated, and hypertension/high blood pressure can be an
indicator of something systemic.
2.) Autoimmune Disease = A condition in which your immune system mistakenly attacks your own body.
Autoantibody = An antibody produced by the immune system that is directed against one or more of
the individual's own tissues and proteins. Many autoimmune diseases are caused by these
autoantibodies. 3.) Environmental triggers associated with Autoimmune Diseases: Climate, stress,
occupation, chemicals, genetics, cigarette smoking, and diet. Growing evidence suggests that
particularly a typical ‘Western diet’, rich in saturated fat and salt and related pathologies can have a
profound impact on local and systemic immune responses. Shifts and reduction in gut microbiota are
tightly connected to the immune system, immune regulatory processes, and autoimmune diseases.
Many autoimmune diseases involve environmental factors that act on top of genetic susceptibility.
4.) Some Autoimmune Diseases include: Systemic Lupus Erythematous, SLE, Sjögren’s syndrome,
Raynaud’s Syndrome, Rheumatoid Arthritis, Multiple Sclerosis, Psoriasis, Grave’s Disease, Hashimoto’s
Thyroiditis, Celiac Disease, Crohn’s Disease, Psoriatic Arthritis, Antiphospholipid Syndrome, and
Scleroderma.
5.) Some typical signs and symptoms of Autoimmune Disease (using Lupus as an example) are: achy
joints (arthralgia), unexplained fever (more than 100 F), swollen painful joints (arthritis), prolonged or
extreme fatigue, skin rash, ankle swelling and fluid accumulation, pain in the chest when breathing
deeply (pleurisy), a butterfly-shaped rash across the cheeks and nose, hair loss, sensitivity to the sun
and/or other light, seizures, mouth or nose sores, and pale/purple finger or toes from cold or stress
(Raynaud’s Syndrome).
6.) Criteria for the diagnosis of:
Systemic Lupus Erythematous (SLE) = Malar rash or skin rash, photosensitivity- unusually strong
reaction to sun light, causing a rash or flare, mouth or nose ulcers, inflammation in two or more joints,
inflammation of the heart lining and/or lungs, neurologic disorder like seizures and/or psychosis, kidney
disorder – increased protein or clumps of red cells in urine, blood disorder – anemia caused by
damaged
\
, red cells, low white cells or low platelet count, immunological disorder – when your immune system
attacks healthy cells, and antinuclear antibodies (ANA) – positive blood test not induced by drugs.
Rheumatoid Arthritis = Rheumatoid arthritis can be difficult to diagnose because the early signs and
symptoms mimic those of many other diseases. There is no one blood test or physical finding to
confirm the diagnosis. However, in blood tests, people with rheumatoid arthritis often have an
elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), which may indicate the
presence of an inflammatory process in the body. Symptoms that begin the diagnosis process include:
Joint pain, chronic stiffness and swelling, swelling affecting 3-4 different joints or more, morning
stiffness, swelling and pain affecting the wrists, hands and finger joints, and Rheumatoid nodules
developing under the skin.
Lyme Disease = A blood test for antibodies to the bacteria is the preferred test for the diagnosis of Lyme
disease. Signs and symptoms of Lyme disease may include: A characteristic "bulls-eye" rash that spreads
from the site of the bite, fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes.
Chronic Epstein Barr Syndrome = It is hard to tell whether or not you have Epstein Barr just by your
symptoms since they are so generic. The proposed diagnostic criteria included the following: 1)
persistent or recurrent infectious mononucleosis-like symptoms; 2) an unusual pattern of EBV
antibodies with elevated anti-VCA and anti-EA, or detection of the EBV genome in affected tissues
including the peripheral blood; and 3) chronic illness that cannot be pinpointed 4) An enlarged spleen
and tonsils
7.) The doctor suspects that Jamie may be anemic because due to the fatigue she is experiencing along
with Jamie’s overall weakness/Lack of stamina. Her slightly elevated heartbeat is also a symptom of
anemia.
ANSWERS to Part 2 – Understanding Results
1.) Abnormal test results include: All CBC lab test results are lower than the average reference range for
women (WBC count, RBC count, Hemoglobin, Hematocrit and Platelet count. ESR (Sedimentation Rate)
is very elevated at 61mm/hr. Iron (Chem Panel Lab Test) is elevated at 189 ug/dL. Immunology Lab Tests
for C-Reactive Protein is inflated at 5.8 mg/L, and VDRL’s are Positive along with Positive ANA’s, which
should both be Negative- indicating abnormal test results.
2.) CBC Lab Test Results: A low WBC count (leukopenia) may be caused by a medical condition, such as
an autoimmune disorder that destroys white blood cells. A low RBC count, a low Hemoglobin, and a
low Hematocrit result indicates anemia. Anemia has many causes, including low levels of certain
vitamins or iron, blood loss, or an underlying condition. However, Jaimie’s Iron count (from her Chem
Panel Results) is elevated- it is NOT low. Therefore, anemia is ruled out and an underlying condition
such as an autoimmune disorder, as mentioned above, is way more likely. Lastly, a platelet count that's
lower than normal (thrombocytopenia) is often a sign of an underlying medical condition as well.
ESR (Sedimentation Rate): Erythrocyte sedimentation rate is a test that indirectly measures the degree
of inflammation present in the body. Inflammation is part of the body's immune response. It can be
acute, developing rapidly after trauma, injury or infection, or can occur over an extended time (chronic)
with conditions such as autoimmune diseases. Considering the fact that Jamie’s ESR Rate is so high, a
chronic and systemic autoimmune disorder is suspected.
Iron (Chem Panel) Test Results: Jamie’s Iron results were high. A condition called Hemochromatosis
causes your body to absorb too much iron from the food you eat. Excess iron is stored in your organs,
especially your liver, heart and pancreas. Too much iron can lead to life-threatening conditions such as
liver disease and heart problems. Some symptoms of this include joint pain, fatigue and overall weakness
which also happen to be signs and symptoms of autoimmune disease.
\
