Immunopathology
Contributed by Li Liu, MD, PhD and Alesia Kaplan, MD
CLINICAL HISTORY
The patient is a woman is her late 30's with a history of recurrent scalp lesion. She presented to her PCP with a 3-day history of inflamed scalp lesion and an enlarged lymph node. Physical examination revealed erythematous skin breakdown at the crown to the right of the midline, but no drainage expressible. There was a large, tender right posterior auricular lymph node. She was treated with Bactrim DS for suspected scalp cellulitis. One week after her initial presentation, she developed a fever, jaundice, emesis and coca cola-colored urine. She presented to an outside hospital and was transferred to UPMC for further evaluation. On admission, she was hemodynamically stable. Physical examination revealed scleral icterus. Relevant laboratory results are shown below.
Laboratory Results
Blood Bank Test Results upon Admission at UPMC
- Direct antiglobulin test (DAT) polyspecific: 3+
DAT anti-C3d: 3+, DAT IgG: 3+ - Antibody screen: positive
- Antibody ID: anti-Jka
- Antibody eluate: anti-Jka
- RBC serotyping: possible Jka mix field, on repeat: weak Jka+
- Molecular typing confirmed Jka+
- Direct antiglobulin test (DAT) polyspecific: 3+
DAT anti-C3d: 3+, DAT IgG: 3+ - Antibody screen: positive
- Antibody ID: anti-Jka
- Antibody eluate: anti-Jka
- RBC serotyping: possible Jka mix field, on repeat: weak Jka+
- Molecular typing confirmed Jka+