Immune Hypersensitivity Disorders
17 cases on colchicine-resistant familial Mediterranean fever, periodic fever syndrome diagnosis before genetic confirmation, PFAPA treatment tradeoffs, drug-induced hypersensitivity reactions (infliximab, vasculitis, checkpoint-inhibitor colitis, vaccine angioedema), CRMO escalation, adult-onset Still's disease, VEXAS syndrome, CAPS/NOMID therapy selection by phenotype and age, IgG4-related disease, IVIG-resistant Kawasaki disease, anti-TNF-induced lupus, interferonopathy, and Schnitzler syndrome — choose a case below to open its full multi-voice debate.
A pastry chef's colchicine-resistant FMF keeps producing subclinical inflammation between attacks. The choice is which IL-1 blocker actually fits her life.
A college sophomore’s decade of unexplained fevers looks like TRAPS, not HIDS — but genetic testing is still six weeks out. The question is whether to wait.
A four-year-old’s monthly PFAPA fevers respond instantly to a single steroid dose — but that same drug may be shortening the gap until the next one.
A five-month gap in her Crohn’s infusions ended with fever, rash, and joint pain after retreatment. The lab that arrives days later reframes the whole decision.
New leg purpura began after two drugs were started the same week. Neither can be cleared as the cause, and the lesions are still spreading two days after stopping both.
A trial already showed early steroids don’t prevent HSP nephritis. It doesn’t say what to do three days into proteinuria that’s already climbing.
Her melanoma is shrinking faster than any prior treatment. The immune colitis that came with it is now severe enough that resuming the drug is no longer a simple call.
She reacted to her first mRNA vaccine dose with facial swelling and throat tightness. On a biologic that makes vaccination especially important, waiting has its own cost.
Four months of naproxen hasn’t stopped new bone lesions from appearing. A fresh one on her sacroiliac joint reopens the whole question of what disease this actually is.
New-onset Still's disease with a strikingly high ferritin raises the question of whether the traditional step-wise treatment ladder is still the safer choice.
His UBA1-mutant marrow is driving both his transfusion-dependent anemia and his auricular chondritis. The two problems don’t obviously point to the same first drug.
His NOMID diagnosis came with active papilledema today. The trial evidence for each IL-1 blocker doesn’t split neatly between the two candidate drugs.
His new IgG4-related disease diagnosis usually starts with high-dose steroids. His diabetes control makes that standard first move a much costlier one for him specifically.
His fever never broke after the first IVIG dose, and his coronary arteries are already showing early change. The best trial comparing second-line options wasn't powered for a patient quite like him.
Her anti-TNF-induced lupus was supposed to resolve once the drug stopped. Six weeks later, her complement is still low and her kidneys have joined the picture.
Her autoinflammatory syndrome doesn't respond to IL-1 blockade, and her interferon signature points elsewhere. The two JAK-pathway drugs on the table have very different amounts of evidence behind them.
His hives partly responded to omalizumab. His fevers and bone pain never did — and those, not the rash, are what actually name his disease.