Janet, a 20 year-old college student, is experiencing a five-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. Janet gets frequent “colds” every spring and fall.
Physical Examination
Vital Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous, with clear postnasal drainage
Lungs: Clear to auscultation and percussion
Discussion Questions:
1. Provide three differential diagnoses based on Janet’s subjective and objective data and discuss your reasoning for each.
2. What additional history questions would be useful in your evaluation of Janet?
3. Discuss the pathophysiological process of your primary diagnosis.
4. Differentiate the types of hypersensitivity mechanisms.
5. As per your analysis, what type of hypersensitivity reaction is Janet experiencing?
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