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1) Ms. X, a 32-year-old Hispanic woman, has had a history of intermittent pleuritic chest pain and joint pain for the past several years. Recently, she went to her physician because she noticed that an erythematous, butterfly-shaped rash had appeared on her face. Further lab tests indicated protein in her urine. Her blood test indicated the presence of numerous antinuclear antibodies, especially anti-DNA, and mature neutrophils containing nuclear material. A diagnosis of systemic lupus erythematosus (SLE) was made.
* Discuss possible reasons why SLE was not diagnosed earlier.
* Discuss how the presence of antibodies can cause such widespread damage in organ systems.
* Discuss treatments for SLE and a prognosis for the patient in this case.
2) Mr. F, age 46 years, has had a persistent unproductive cough for several months that did not respond to cough medications. Recently, he has developed a productive cough accompanied by fatigue, anorexia, and night sweats. Examination indicated abnormal chest sounds and weight loss. A chest radiograph showed a small cavity and infiltrate, the tuberculin test was positive, and the sputum sample contained a small amount of blood and numerous acid-fast bacilli, confirming the diagnosis of active tuberculosis.
* Discuss the pathologic changes occurring during the development of active tuberculosis.
* Discuss the transmission of TB and the conditions predisposing to the development of TB.
* Discuss the treatment of tuberculosis and the precautions involved for health care personnel coming into contact with the patient.
* Suggest how family members or co-workers can protect themselves.
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