For each of the clinical scenarios in questions 7-10, choose the hypersensitivity type (A-D) that best matches the associated immunologic disease. (Answers may be used more than once.)
A. Type I hypersensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity
A 5-year-old girl is taken to the emergency department with lethargy, confusion, vomiting, abdominal pain, and flushed skin that is warm to the touch. Respirations are fast and shallow (Kussmaul) and emanate a strong, fruity odor. The mother notes that the child has been excessively thirsty over the past week and that she began wetting her bed during naps. Urine dipstick testing reveals markedly elevated levels of glucose and ketones.
ANS: D. This patient is in diabetic ketoacidosis, a serious complication of her previously undiagnosed insulin-dependent diabetes mellitus (type 1). Her insulin deficiency results from destruction of the insulin-producing beta cells of the islets of Langerhans in the pancreas. Several mechanisms may contribute to beta cell destruction. Prominent among these mechanisms are type IV (delayed-type) hypersensitivity reactions mediated by CD4+ TH1 cells reactive with islet antigens, and cytotoxic T-lymphocyte (CTL)-mediated lysis of islet cells.
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