0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

DIAGNOSIS

■ Clinical diagnosis with history of inciting agent
■ Serum complement (C3,C4) levels will be decreased.

TREATMENT

■ Stop offending agent.
■ Antihistamines, NSAIDs, steroids
■ Plasmaphoresis for severe symptoms is not responsive to other treatments.

INFLAMMATORY DISORDERS

Reiter’s Syndrome

Seronegative spondyloarthropathy that is predominantly seen in young males.
The triad of symptoms is usually preceded by an infection caused by Chlamy-
dia,Shigella, or Salmonella. The syndrome lasts from one to several months
and may recur.

SYMPTOMS/EXAM

■ Asymmetric oligoarthritis: Especially of lower extremities
■ Urethritis
■ Conjunctivitis

TREATMENT

■ Treat urethritis for ChlamydiaandGonorrheabecause of frequency of co-
existing infection.
■ Patients with recurrent ocular inflammation may require immunosuppresants.
■ NSAIDs for arthritis

Systemic Lupus Erythematosus

This multisystem inflammatory disorder is mediated by autoantibodies. SLE is
usually first diagnosed in women of childbearing age. Disease course is highly
variable and patients may have acute flares. Drug-induced SLE is often reversible.

SYMPTOMS/EXAM

■ Constitution symptoms, including fatigue, malaise, weight loss, fever
■ Malar or discoid rash, photosensitivity
■ Oral ulcerations
■ Arthralgias, arthritis, myalgias
■ Serositis: Pleuritis, pericarditis
■ Seizure, stroke, psychosis

DIAGNOSIS

■ Hematologic findings include hemolytic anemia, thrombocytopenia,
leukopenia.
■ Persistent proteinuria (nephritis) is common.
■ The presence of four of 11 criteria outlined in mnemonic DOPAMINE
RASH is diagnostic.
■ During acute flares, there is a decrease in C3, C4 levels but an increase in
ESR and CRP levels.

Serum sickness occurs 6—21

days after exposure to foreign

antigen or 1—4 days after a

reexposure. Symptoms that

occur during the initial

treatment of a crotalidae

envenomation are notdue to

serum sickness.

SLE is associated with

accelerated ischemic coronary

artery disease, and has

earned, along with diabetes,

the status of “CAD-risk

equivalent.”

Reiter’s syndrome

symptoms:

Can’t see(conjunctivitis)

Can’t pee(urethritis)

Can’t climb a tree

(arthritis).

SLE criteria—

DOPAMINE RASH

Discoid rash

Oral ulcers

Photosensitive rash

Arthritis

Malar rash

Immunologic criteria

(+anti-dsDNA test or

+anti-Sm test)

NEeurologic or

psychiatric symptoms

Renal disease

ANA+

Serositis (pleural,

pericardial, peritoneal)

Hematologic disorders