Diseases of Immunity

CS # 87 - Acute proliferative post

streptococcal
This glomerulus is hypercellular and capillary loops are poorly defined. This is a type of
proliferative glomerulonephritis known as post-infectious glomerulonephritis. This case
followed a group A beta hemolytic streptococcal infection of the pharynx 3 weeks earlier.
CS # 87 - Acute proliferative post
streptococcal
The hypercellularity of post-infectious glomerulonephritis is due to increased
numbers of epithelial, endothelial, and mesangial cells as well as neutrophils in and
around the glomerular capillary loops. This disease may follow several weeks after
infection with certain strains of group A beta hemolytic streptococci. Patients who
have had a strep infection typically have an elevated anti-streptolysin O (ASO) titer.
CS # 42 - TB, lungs
Well-defined granulomas are seen here. They have rounded outlines. The one
toward the center of the photograph contains several Langhans giant cells.
Granulomas are composed of transformed macrophages called epithelioid cells
along with lymphocytes, occasional PMN's, plasma cells, and fibroblasts. The
localized, small appearance of these granulomas suggests that the immune
response is fairly good.
CS # 42 - TB, lungs
At low magnification, this photomicrograph reveals multiple granulomas.
Granulomatous disease by chest radiograph can appear as reticulonodular densities.
CS # 42 - TB Lungs
The edge of a granuloma is shown here at high magnification. At the upper right is
amorphous pink caseous material composed of the necrotic elements of the
granuloma as well as the infectious organisms. This area is ringed by the
inflammatory component with epithelioid cells, lymphocytes, and fibroblasts.
CS # 42 - TB, lungs
At high magnification, the granuloma demonstrates that the epithelioid
macrophages are elongated with long, pale nuclei and pink cytoplasm. The
macrophages organize into committees called giant cells. The typical giant cell for
infectious granulomas is called a Langhans giant cell and has the nuclei lined up
along one edge of the cell. The process of granulomatous inflammation takes place
over months to years (did you ever hear of a committee action that was completed
in a short time?)
CS # - Lupus eryhtematosus, Spleen
The periarteriolar fibrosis ("onion skinning") seen in the spleen in patients with SLE at
autopsy is quite striking, though of no major clinical consequence. This results from
vasculitis.
CS # 253 Lupus erythematosus,
kidney
One of the feared complications of the autoimmune diseases is renal failure. This is most
likely to occur with SLE and the diffuse form of scleroderma. Here is a glomerulus in
which the capillary loops are markedly pink and thickened such that capillary lumens
are hard to see. This is characteristic for lupus nephritis.
CS # 253 Lupus erythematosus,
kidney
Here is a glomerulus with thickened pink capillary loops, the so-called "wire loops",
in a patient with lupus nephritis. The surrounding renal tubules are unremarkable.