Clinical immunology is a specialty in its own right and there are many excellent textbooks devoted to it. Here we can only summarize the most common conditions encountered by the clinical immunologist, arranged by organs and/or systems rather than, as elsewhere in this book, by mechanism. Obviously there are frequent overlaps with other disciplines, which is why the clinical immunologist is expected to be familiar with all branches of pathology and medicine. For example, a case of myeloma could present to the accident and emergency department (A&E) with a fracture or be referred to the rheumatology department because of bone pain, to urology because of renal failure, to haematology because of anaemia, to immunology because of immunodeficiency, or even to the neurology or eye clinic. Abnormalities may be picked up by the radiologist, by the haematologist in a marrow biopsy, or simply from serum electrophoresis or a urine test. In the same way any patient with liver, kidney, lung, joint or skin disease, or with an unusual infection, should be looked at with the immunological possibilities in mind. The figure can be used as a checklist; brief details are provided on the opposite page. Remember that immune status is critical when considering vaccination, transplantation and in monitoring the course of AIDS.

CNS 

Blood–brain barrier keeps out most infections.

• Meningitis: usually bacterial; encephalitis more often viral (NB prions: Creutzfeldt–Jakob disease [CJD]).
  
• Multiple sclerosis: plaques of demyelination in brain, with Ig in cerebrospinal fluid (CSF); progressive with remissions, IFNβ delays progression.
  
• Guillain–Barré syndrome: demyelination in peripheral nerve post infection; normally complete recovery.
  
• Myasthenia gravis: autoimmune destruction of acetylcholine receptors at nerve–muscle junction; muscle fatigue; maternal antibody can affect neonate; plasmapheresis to remove antibody.

Eye 

The eye, open to the air, is protected from infection by tears, lysozyme and IgA.

• Common infections: adenovirus, Streptococcus pneumoniae (conjunctiva), trachoma (eyelid), CMV, Toxoplasma spp. (retina), congenital rubella (lens).
  
• Uveitis: common in rheumatic and other systemic autoimmune diseases.
  
• Sympathetic ophthalmia after unilateral damage.
  
• Corneal grafts: 65% non-rejection.

Liver

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Recognition and receptors: the keys to immunity The T-cell receptor Cell-mediated immune responses HIV and AIDS Immunodeficiency Immunostimulation and vaccination

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