Question

Differential Diagnosis and Treatment of an Immune Response

by Alisa J. Petree, Medical Laboratory Technician Program Sondra A. Dubowsky, Biology Department Mary A. Sides, Biology Department McLennan Community College, Waco, TX

Part I – The Investigative Process

Jamie is a 26-year-old graduate student at the University of Arkansas—Monticello. She is working on her PhD in biology. As a biologist, she enjoys spending time outdoors when she can. The campus is on the edge of the woods and it is a nice place for Jamie to walk and relax to relieve the stress of graduate school. Jamie has not been able to enjoy her walks lately due to the fatigue she has been experiencing. Others have noticed that she does not have the stamina she had in the past to complete her research. Her major professor convinces her that it would be a good idea to make an appointment to see her family physician to determine the source of her fatigue. He suggests that maybe she has a viral infection, and she just needs to get some rest.

She is able to get an appointment with her family practitioner. When she arrives at the clinic, the nurse takes her blood pressure and temperature. Her blood pressure is 128/74 and her temperature is a slightly elevated 101.20F. She is asked to provide her family medical history and to describe any symptoms she has noticed. Jamie tells her doctor that her maternal grandmother had rheumatism and was not able to get around. Her father had prostate cancer. She cannot think of any other family illnesses. She tells her doctor that in addition to feeling run down, her knees and elbows have been aching, and she has been having trouble pipetting because of pain in her hands. She has been experiencing frequent cold sores that she has been treating with over-the-counter medication. She attributes her recent weight loss to poor eating habits as a student.

On general examination, the doctor finds a rash on her upper back where she is typically exposed to the sun and swollen lymph nodes on her neck. The doctor decides that further tests are required to rule out some obvious possibilities. He suspects an autoimmune disease such as lupus (systemic lupus erythematous, SLE) or rheumatoid arthritis (RA), a tick born disease like Lyme disease, anemia, or chronic Epstein Barr virus syndrome. Jamie is sent to the lab where blood is drawn. She is asked to return the following week to review the lab test results.

What information provided by Jamie would lead the physician to suspect a systemic disease?

	A.	fatigue and loss of stamina and slight fever
	B.	aching in the knees, elbows, and hands
	C.	cold sores, weight loss, and rash on upper back
	D.	all of these

Answer 1

Correct answer : option D

Explanation:

• All the symptoms described suggest systemic disease.
• The first stage of any disease is inflammation.
• Inflammation leads to reduce muscle mass and reduces appetite. (IL-6 and IL-1beta)
• As a result, an individuals stamina reduces
• Inflammation can lead fever as well
• Interleukin 1 and 6 and Tumor necrosis factor can induce fever.
• Joint pain fever and rash all suggested some underlying connective tissue disorder.
• Connective tissue disorders are know to cause weight loss and muscle wasting.
• Therefore, a systemic illness is more likely in this patient