Review Question - QID 213888

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Systemic Lupus Erythematosus Introduction Pathogenesis QID: 213888 (M1.OMB.20.1)

QID 213888 (Type "213888" in App Search)

A 31-year-old woman presents to her primary care physician with a 2-month history of joint pain. She says that she has been getting increasing joint pain in her hands and feet that has been interfering with her ability to work as a secretary. Furthermore, she has noticed that she has been getting numerous oral ulcers over the same time period even though she never had ulcers before. Her husband is worried because she sometimes appears to be confused and acts erratically during these times. Physical exam reveals edema of the legs bilaterally and a new systolic murmur best heard in the right upper sternal border around the second rib. Which of the following types of hypersensitivity is most likely responsible for this patient's edema?

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Type 1

6/259

Type 2

17%

44/259

Type 3

50%

129/259

Type 4

11%

29/259

Types 2 and 3

16%

41/259

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This patient who presents with joint pain, oral ulcers, neurologic findings, peripheral edema, and a new systolic murmur most likely has systemic lupus erythematosus. Lupus nephritis is due to a type 3 hypersensitivity reaction.

Systemic lupus erythematosus (SLE) is an autoimmune disease that is classically characterized by acute flares with rash, joint pain, and fever being common presenting symptoms. Cutaneous findings include a malar rash that spares the cheeks, a discoid rash with follicular plugging and scale, aphthous ulcers, and a photosensitivity rash. Lupus can also involve many organ systems with renal, neurologic, cardiovascular, and hematologic manifestations in different patients. Notably some of these manifestations such as lupus nephritis are caused by the deposition of immune complexes with subsequent proteinuria and hematuria. Other manifestations such as anemia are caused by direct antibody cross reactivity with endogenous antigens on the red blood cells.

Incorrect Answers:
Answer 1: Type 1 hypersensitivity is caused by IgE linked release of vasoactive amines. This type of hypersensitivity is most commonly seen with atopic disorders such as anaphylaxis or allergic rhinitis.

Answers 2 & 5: Type 2 hypersensitivity involves the direct binding of antibodies to endogenous antigens. Some aspects of lupus (e.g., anemia) involve type 2 hypersensitivity; however, the edema due to lupus nephritis is a type 3 hypersensitivity reaction.

Answer 4: Type 4 hypersensitivity reaction involves the targeting of endogenous cells by killer CD8+ T-cells. This type of hypersensitivity is most commonly seen with type 1 diabetes and contact dermatitis.

Bullet Summary:
Lupus nephritis is caused by a type 3 hypersensitivity reaction with deposition of immune complexes in the glomeruli.

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