Chill Bro
These are the three primary pharmacologic categories involved in treating type 1 hypersensitivity reactions
Adrenaline (epi) - bronchiole dilation, blood vessel constriction
Antihistamines - reduce inflammation
Corticosteroids - reduce inflammation
Atypical infections post-transplant are most commonly seen in this time period.
What is 1-6 months?
Strong levels of immunosuppression mean opportunistic infections like toxoplasmosis and aspergillosis or latent infections like CMV or HSV can arise
This mnemonic helps you remember the symptoms of Kawasaki disease. [Must also explain mnemonic with no more than 1 incorrect]
What is CRASH and BURN?
Conjunctivitis [non-purulent]
Rash [non-vesicular]
Adenopathy [typically cervical]
Strawberry tongue
Hand and foot swelling / erythema
Burn: 5 days of fever
This arthralgic condition is typically seen days to weeks after a GI or GU infection [and has a rhyming mnemonic]
Reactive arthritis - can't see, can't pee, can't climb a tree
Treatment: abx if infectious cause + NSAIDs
This common post-transplant medication can cause nephrotoxicity and neurotoxicity. A level should be measured in patients.
What is tacrolimus? [prograf]
- calcineurin inhibitor, like cyclosporine
This type II hypersensitivity reaction may be treated with neostigmine or pyridostigmine
What is myasthenia gravis?
Type II: antibody-mediated
This type of transplant rejection is rarely seen in the ED, and is caused by pre-formed antibodies.
What is hyperacute rejection?
The CDC definition of this pediatric disease includes failure of at least 2 organ systems, fever, and recent infection or exposure to Covid
What is MISC?
- only 19 verified cases
- common presenting symptoms include erythematous rash, headache, GI involvement, and several days of fever
The treatment of rabies or snakebite may trigger this reaction, which may present up to two weeks after exposure.
What is serum sickness?
Pruritic rash, arthralgia, fever, and more
Weight gain, skin thinning, GI bleeding, hyperglycemia, and psychological effects are also potential adverse effects of what immunosuppresive class?
What are corticosteroids?
This type of hypersensitivity often causes glomerular disease.
What is type III (immune complex mediated) hypersensitivity?
This type of transplant rejection is mediated by antibody and cell-mediated rejection
What is chronic transplant rejection?
This is the most common infectious cause of this reaction in the pediatric population.
What is HSV? Causing erythema multiforme
[Also Mycoplasma pneumonia, but HSV accounts for 70-90% of cases]
This is the classic tetrad of symptoms of this disease: [name at least 3]
What is purpura, arthritis, abdominal pain, renal disease?
IgA Vasculitis [formely henoch schonlein purpura]
This drug has a cytostatic effect on B and T cells. Common adverse effects include abdominal pain, anoxeria, nausea/vomiting, and anemia
What is cellcept? (mycophenolate mofetil)
Suspect this common cause of glomerular hematuria in someone with a recent respiratory infection.
What is PSGN?
Management: supportive [+abx if infection still present]
This transplant complication can present with B symptoms such as fever and weight loss, as well as lymphadenopathy.
What is posttransplantation lymphoproliferative disorder?
- from polyclonal hyperplasia to lymphoma
- highest risk in heart and lung transplants
This named sign can help you differentiate pemphigus vulgaris from bullous pemphigoid.
[Must name the sign and explain which finding is which]
What is Nikolsky sign?
Skin sloughing with gentle pressure is seen in pemphigus vulgaris [and TEN / SJS]
This nonbacterial endocarditis is associated with an immune complex disease. [Name the endocarditis and the immune complex disease]
What are Libman-Sacks and SLE?
Most common cardiac manifestation: pericarditis
This drug block nucleotide production in immune cell replication and may cause bone marrow suppression, macrocytosis, anemia, and pancreatitis
What is azathioprine? (imuran)
This type 4 hypersensitivity is most commonly associated with phenytoin, phenobarbital, allopurinol, and sulfa medications.
What is DRESS syndrome?
Drug Rash with Eosinophilia and Systemic Symptoms
Consider this condition in stem cell recipients presenting with a nonspecific rash and / or diarrhea within 100 days of transplantation
What is acute graft vs host disease?
[In GvHD, the transplanted cells attack the host, vs the host attacking the transplant in rejections]
A bite from this creature might make you allergic to meat
What is the Lone Star tick?
- Alpha gal syndrome
- Also can cause ehrlichiosis
This very rare reaction was first reported after repeated subcutaneous injections of horse serum into rabbits. [But has also been reported after tetanus and diphtheria toxoid vaccination]
What is Arthus reaction?
Local vasculitis 4-12 hours post-injection.
This transplant medication blocks the mTOR receptor and may cause thrombocytopenia, leukopenia, diarrhea, and mucosal irritation
What is sirolimus? (rapamune)