The immune system and disease: a presentation of five cases

Abstract

Autoimmune phenomena have been found to occur in an expanding catalogue of disease, and clinical interest is growing as new therapeutic interventions become available. In this entry for the Wightman Prize in Clinical Medicine, five patients are presented in each of whom the immune system made some contribution to their illness. Each of these patients were clerked by the author in the Spring of 1988, while attached to wards 32 and 33 of the Royal Infirmary of Edinburgh.• Case 1: A proximal myopathy due to Grave's disease • Case 2: Haematemesis: Primary Biliary Cirrhosis • Case 3: A self-limiting Haemolytic Anaemia • Case 4: Pernicious Anaemia • Case 5: Diabetic KetoacidosisThe spectrum of disease in which the immune system contributes to the patient's illness is illustrated by the five cases presented here. Each condition could have been diagnosed clinically on the basis of the history, examination and simple urialysis, but the diagnoses were each substantiated by laboratory investigations which are largely based on our understanding of the disease process. A more profound understanding of the molecular and cellular events underlying these diseases may allow us to evolve novel therapeutic approaches in the future, as it has done for the once fatal diseases diabetes and pernicious anaemia in the past. For example, the goal of antigen- specific immunosuppression becomes closer with our emergent understanding of regulation in the immune system. However, as in the case of Miss C, illnesses are not just a consequence of deranged physiology or an internal threat from the immune system within: they are related to patients' interactions with their families and the people around them. Responding to this is also part of the challenge of Clinical Medicine.