Pleno Skenario 4

Hypersensitivity and Autoimmune

Disease
Kelompok 13
Fakultas Kedokteran
Universitas Lampung
 Skenario 4
Feeling dizzy and blurring eyes after injection

Mrs. Sarah 40 years old, come to the doctor

complaining about her joint discomfort. She feels it
every morning in her knees and hands. Her knee is
swelling and she feel ache in her arm. After following
the historical diseases, sarah said that she often had
cough, flu, and sorethroat. Because she already bored
consuming drugs. Sarah want to be injected by
analgetik. After doctor asks about the history of drug
allergic and she hasnt have it, sarah is injected with
an analgetic. Few times later, sarah feel dizzy, bluring
eyes and hard to breath. What is actually happened
to sarah
 STEP 1

There arent found difficult word

 STEP 2

1. Explain about the symptoms in the

scenario!
2. Diagnosis differential of diseases in the
scenarios!
3. Mentioned drugs that may be
consumed by sarah until she bored!
4. Mention other actions to be performed
doctor!
 STEP 3 and STEP 4
1.

a. Joint discomfort in knees and hands, knee is swelling and feel

ache in her arm

associated with hypersensitivity type 3, precipitates antigen-

antibody complexes in the blood vessels or tissue. A heap of
immune complexes in the tissue causes the complement protein
activation type 1 (C1) which then triggers activation of classical
complement pathway. In the end, there will be migration of
immune cells such as neutrophils, basophils, daneosinofil also
release inflammatory mediators and cause inflammation of the
joints
b. After injected with an analgetic, feels dizzy, blurring eyes and
hard to breath.

associated with type I hypersensitivity reactions, which is an

allergic reaction that occurs due to exposure to specific antigens
are known as allergens. Can be exposed in a way swallowed,
inhaled, injected, or direct contact. Presence of allergens in the
first contact stimulate B cells to produce antibodies, ie IgE. At the
time of re-contact with the allergen, the allergen binds to IgE
antibodies bind to mast cells or basophils in and cause
granulation. Degranulation caused the release of inflammatory
mediators (example : histamin can causes including increased
permeability of blood vessels and smooth muscle contraction)
accumulation of mucus in the lung alveoli and contraction of
smooth muscle contraction that narrows the airway to the lungs so
that be hard to breath
2. Diagnosis Differential : Arthritis reumatoid,
Hypersensitivity type 3 and Hypersensitivity
type 1

3. Drugs that may be consumed by sarah

OAINS, Glukokortikoid, DMARD

4. Giving antihistamin to block action of histamin

on vessels and smooth muscles.
Phosphodiesterase inhibitors to relax broncial
smooth muscle
 STEP 5

1. Explain about rheumatoid arthritis,

polymyalgia rheumatica, systemic lupus
erythematosus!
2. Explain about Autoimmune!
3. Explain manifestation of Steven Johnson
Syndrom, Henoch Schonlein Purpura,
Juvenil Chronic Arthritis!
4. Complication of Systemic Lupus
Eritematosus (scleroderma, polyarthritis
nodusa, vasculitis lupus)!
 STEP 7
Number 1
 A. Rheumatoid Arthritis
Rheumatoid Arthritis is autoimmune disease characterized by chronic and
progressive systemic inflammation in which the joints are the main target

Etiology :

Faktor Genetik
Hormon Sex
Faktor Infeksi
Protein Heat Shock (HSP)

Manifestation :

Articular Manifestation
pain and stiffness in many joints, commonly affected joints of the hands,
feet, cervical spine
Extraarticular Manifestation
Nodul rheumatoid in the skin, commonly found in the region of the ulna,
olecranon, fingers, Achilles tendon or bursa olecranon
 B. Polymyalgia Rheumatica
Polymyalgia rheumatica (PMR) is a relatively common chronic inflammatory
condition of unknown etiology that affects elderly individuals.

Etiology :

The exact cause (or causes) of PMR is unknown.

The disease is more common among Northern Europeans, which may
indicate a genetic predisposition. Other risk factors for PMR are an age of
50 years or older and the presence of GCA.
An autoimmune process may play a role in PMR development. PMR is
associated with the HLA-DR4 haplotype. High level of IL-6 is associated with
increased disease activity.

Manifestation :

proximal myalgia of the hip and shoulder girdles with accompanying

morning stiffness that lasts for more than 1 hour.
C. Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that has protean
manifestations and follows a relapsing and remitting course. It is characterized by an
autoantibody response to nuclear and cytoplasmic antigens. SLE can affect any organ
system, but it mainly involves the skin, joints, kidneys, blood cells, and nervous system

Etiology:

Although the specific cause of SLE is unknown, multiple genetic predispositions and gene-
environment interactions have been identified.

Manifestation :

Constitutional ( fatigue, fever, arthralgia, weight changes)

Musculoskeletal ( arthralgia, arthropathy, myalgia, frank arthritis, avascular necrosis)
Dermatologic ( malar rash, photosensitivity, discoid lupus)
Renal ( acute or chronic renal failure, acute nephritic disease)
Neuropsychiatric ( seizure, psychosis)
Pulmonary ( pleurisy, pleural effusion, pneumonitis, pulmonary hypertension, interstitial
lung disease)
Gastrointestinal ( nausea, dyspepsia, abdominal pain)
Cardiac ( pericarditis, myocarditis)
Hematologic ( cytopenias such as leukopenia, lymphopenia, anemia, or thrombocytopenia)
 STEP 7
Number 2
Autoimmune

Autoimmune is the response immune

of own tissue of antigen caused by loss
tolerance -> cannt maintain self-
tolerance B cell or T cell or both

Antigen -> Auto Antigen

Antibody -> Auto Antibody
 Autoimmune Disease
1. Antibody Mediated 4. Autoimmune Specific Organ
- Thyrotoxicosis
- Addison's disease
- Pernicious Anemia
- Autoimmune hemolytic disease
- Myasthenia Gravis - Pernicious anemia
- Gullain-Barre syndrome of
2. Immune Complex Mediated peripheral nerves (gangliosides)
- Systemic Lupus - Acute disseminating
Erythematosus encephalomyelitis
- IDDM
- Rheumatoid Arthritis
- Goodpasture's syndrome
- Vasculitis - Graves Disease
- Hashimoto's thyroiditis
3. Cell Mediated Disease - Myasthenia gravis
- Diabetes Mellitus - Sjogren's syndrome
- Polymyositis Muscle
- Multiple Sclerosis
 STEP 7
Number 3
 Manifestation of Steven
Johnson Syndrom
In addition to the skin, Ocular symptoms include the
following:
lesions in Stevens-Johnson
syndrome may involve the Red eye
following parts of the body: Tearing
Dry eye
Oral mucosa Pain
Esophagus Blepharospasm
Itching
Pharynx Grittiness
Larynx Heavy eyelid
Anus Foreign body sensation
Trachea Decreased vision
Burn sensation
Vagina Photophobia
Urethra Diplopia
 Manifestation of Henoch
Schonlein Purpura
The typical prodrome of HSP includes the following:

Headache
Anorexia
Fever

Subsequently, symptoms develop, of which the following are the most

common:

Rash (95-100% of cases), especially involving the legs; this is the hallmark
of the disease
Abdominal pain and vomiting (35-85%)
Joint pain (60-84%), especially involving the knees and ankles
Subcutaneous edema (20-50%)
Scrotal edema (2-35%)
Bloody stools
 Manifestation of Juvenile
Chronic Arthritis
limping
stiffness when awakening
reluctance to use an arm or leg
reduced activity level
persistent fever
joint swelling
difficulty with fine motor activities
 STEP 7
Number 4
 Complication of SLE
1. Scleroderma

is a disease affecting the skin and other organs of the body. Scleroderma is one of the autoimmune
rheumatic diseases, meaning that the body's immune system is acting abnormally. The main
finding in scleroderma is thickening and tightening of the skin, and inflammation and scarring of
many body parts leading to problems in the lungs, kidneys, heart, intestinal system and other
areas.

2. Polyarthritis Nodusa

is a systemic vasculitis characterized by necrotizing inflammatory lesions that affect medium-sized

and small muscular arteries, preferentially at vessel bifurcations, resulting in microaneurysm
formation, aneurysmal rupture with hemorrhage, thrombosis, and, consequently, organ ischemia or
infarction.

3. Vasculitis Lupus

Vasculitis refers to inflammation of the blood vessels. These vessels include arteries and veins.
Vasculitis can result in poor blood flow to tissues throughout the body, such as the lungs, nerves
and skin.
Thank you for your
attention