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drfax
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10/01/06 - 09:09 AM       #1

A 29-year-old man has developed marked abdominal pain over the past week. On physical examination, there is diffuse abdominal tenderness with decreased bowel sounds, but no masses are noted. The stool is negative for occult blood. Laboratory studied show a serum creatinine level of 4.4 mg/dL and urea nitrogen level of 42 mg/dL. Microscopic examination of a renal biopsy specimen shows focal fibrinoid necrosis of the small arterial and arteriolar vascular media as well as intravascular microthrombi. Scattered neutrophils are seen in these areas of necrosis. Which of the following laboratory findings would most likely be present in this patient ?

A. Increased IgE
B.Neuropenia
C.Decreased complement C3
D.Tuberculin skin test positivity
E.CD4 lymphocytosis


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Leopard
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10/01/06 - 09:15 AM       #2

Seems to be a case immune complex vasculitis -----------> Decrease in complement C3

Best of luck


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young_doc
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10/01/06 - 09:37 AM       #3

C.

Sounds like Polyarteritis Nodosa.


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klimt
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10/01/06 - 09:53 AM       #4

C

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Leopard
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10/01/06 - 10:49 AM       #5

young_doc wrote:
C.

Sounds like Polyarteritis Nodosa.



Are you sure PAN involves "arterioles" ???

Best of luck


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drfax
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10/01/06 - 11:24 AM       #6

No one of these diagnosis are true,

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Leopard
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10/01/06 - 11:31 AM       #7

drfax wrote:
No one of these diagnosis are true,



That is great drfax

Then hands up.Please disclose the answer it seems to be some very interesting case.

Thanks in advance


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drfax
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10/01/06 - 11:50 AM       #8

yes leopard,
I said no one of these diagnosis is true, but the answers are right, it is C. but not because of vasculitis or ... but it is an Arthus reaction
Have u noticed the term "intravascular thrombi" so it is not just vasculitis only.



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Leopard
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10/01/06 - 12:02 PM       #9

drfax wrote:
yes leopard,
I said no one of these diagnosis is true, but the answers are right, it is C. but not because of vasculitis or ... but it is an Arthus reaction
Have u noticed the term "intravascular thrombi" so it is not just vasculitis only.




Then you are mistaken .Arthus reaction is in vascular walls -------------> fibrinoid necrosis -----------> microthrombi (due to damaged vessel walls).

Secondly immune complex reactions are of two types
  1. Localized = called arthus reaction
  2. Generalized = serum sickeness

Immune complex vasculitis if localized then ia an example of "arhus reaction"

Best of luck


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