MICROBIOLOGY AND IMMUNOLOGY VMS I, 2002

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MICROBIOLOGY AND IMMUNOLOGYVMS I, 2008
PROBLEM 6 PUFFY EYES, FEVER AND RASH LUC VAN
KAER, PhD
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CASE DESCRIPTION A 12-year-old girl was brought
to the Childrens Hospital Emergency Room because
of a high fever, cough and shortness of breath
for 2 days. Based on physical exam and chest
X-ray a diagnosis of pneumonia was made. Sputum
samples grew Streptococcus pneumoniae.She was
admitted to the hospital and treated with
intravenous penicillin. She gave no history of
allergy to penicillin. On the fifth day of
treatment, she felt remarkably better and had no
fever. Plans for a discharge from the hospital
were made for the following day.
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CASE DESCRIPTION The next morning, she had
puffy eyes and welts resembling large hives on
her abdomen. She was given the anti-histamine
Benadryl orally and penicillin was discontinued.
Two hours later she felt a tight feeling in her
throat, had a swollen face, widespread urticaria
(hives), wheezing and fever. The rash spread,
lymph nodes and spleen became enlarged, and
ankles and knee joints were swollen and tender to
palpation.
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CASE DESCRIPTIONShe was started on the
corticosteroid prednisone, with gradual
improvement of all symptoms. She was discharged
7 days after the onset of the puffy eyes and
rash.
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Questions1) What are these symptoms caused
by?2) How would you prove your
hypothesis?3) What are the mechanisms
responsible for these symptoms?
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Questions4) How is T cell help provided in
this case?
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Questions5) How does the pathogenesis of this
disease relate to the immune response mediated
by haptens and hapten- carrier conjugates?
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Questions6) How could you employ this
principle for vaccine development against
polysaccharides within the capsule of
pathogenic bacteria (e.g., Streptococcus
pneumoniae and Haemophilus influenzae)?
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Conjugate Hib vaccine