Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized primarily by inflammatory polyarthritis, although extra-articular manifestations, including pericardial disease, are well recognized. While pericardial effusions are relatively common, large symptomatic effusions causing cardiac tamponade as the initial manifestation of RA are exceedingly rare. We report a 75-year-old woman with hypertension and dyslipidemia who presented with progressive dyspnea and fatigue one month after an episode of right-hand monoarthritis with an initially unrevealing rheumatologic evaluation. Electrocardiography demonstrated low-voltage QRS complexes, and bedside echocardiography revealed a large pericardial effusion with tamponade physiology. She underwent urgent surgical pericardial window, and pericardial fluid analysis excluded infectious and malignant etiologies. Notably, the erythrocyte sedimentation rate and C-reactive protein were both normal, and the fluid met an exudative threshold on protein content alone.Autoimmune testing demonstrated markedly elevated rheumatoid factor (246 IU/mL), positive antinuclear antibody (1:1280), and strongly positive anti-cyclic citrullinated peptide antibodies, supporting a diagnosis of seropositive RA. Treatment with high-dose intravenous methylprednisolone followed by an oral prednisone taper resulted in significant clinical improvement. This case highlights that cardiac tamponade may precede the classic manifestations of RA, delaying diagnosis. It underscores the importance of early bedside echocardiography and consideration of autoimmune etiologies in patients with unexplained pericardial effusions after common causes have been excluded, as prompt recognition and immunosuppressive therapy can be lifesaving.

Collagenous gastritis (CG) is a rare inflammatory disorder of the stomach and an uncommon but important cause of iron-deficiency anemia in children. Currently, there are no accepted therapeutic guidelines for treating these patients. We report a case in an 11-year-old boy who presented with recurrent iron-deficiency anemia requiring blood transfusion with an ultimate diagnosis of CG on repeat endoscopy. While iron supplementation and proton pump inhibitors failed to achieve clinical remission, the addition of oral prednisone effectively corrected the anemia. Notably, endoscopy improved despite persistent histologic damage. Our case demonstrates that CG should be considered in children with recurrent iron-deficiency anemia. It also underscores the potential role of corticosteroids in the treatment of refractory patients, which can achieve clinical remission even without histological improvement.

Cryptogenic organizing pneumonia (COP) is an important subtype of idiopathic interstitial pneumonia, triggered by abnormal inflammatory responses of the lung to unknown stimuli. The disease shows good initial sensitivity to glucocorticoid therapy, but ~50% of patients experience recurrence after glucocorticoid dose reduction or withdrawal. Cases of multiple recurrences (≥3 times) are rarely reported clinically, and no unified consensus has been formed on their diagnosis and treatment strategies, making clinical management challenging. In the present study, a 53-year-old female patient was admitted to hospital for the first time, presenting with a recurrent cough for >1 month. Chest computed tomography (CT) revealed multiple areas of increased density in both lungs, with no notable absorption of the lesions following antimicrobial therapy. A CT-guided percutaneous lung biopsy revealed widened alveolar septa with numerous fibroblast clusters and foam cells within the alveolar spaces, consistent with a diagnosis of COP. Following treatment with methylprednisolone combined with anti-infective therapy, the lesions largely resolved. The patient was discharged on a tapering regimen of oral prednisone, completing a total treatment course of 2 months. After discontinuing medication for 18 months, the patient was readmitted due to chest tightness. CT revealed recurrence of the bilateral pulmonary lesions. Treatment with methylprednisolone combined with anti-infective therapy was administered. Following discharge, oral methylprednisolone therapy for 5 months resulted in complete resolution of the lesions. After 16 months of low-dose oral methylprednisolone maintenance therapy, the patient presented for a third visit with a cough and chest tightness. Chest CT confirmed recurrence of the COP. Symptoms improved after oral prednisone administration, but radiographic changes remained minimal. Multiple recurrent COP has clinical characteristics of migratory lesions, glucocorticoid sensitivity and easy recurrence, and a pathological biopsy is the key to its diagnosis. Long-term glucocorticoid maintenance and individualized dose reduction regimens may reduce the risk of recurrence, but the optimal treatment plan still needs to be explored in further clinical studies. The present case can provide a practical reference for the diagnosis and treatment of multiple recurrent COP.

Sarcoidosis is a systemic granulomatous disorder, and chylothorax is a rare but severe pleural complication of this disease and exhibits a prominent diagnostic overlap with tuberculosis. The present study reported the case of a 48-year-old woman who was admitted in May 2018 with chronic cough and chest tightness. After hospitalization for 17 days, comprehensive examinations excluded tuberculosis and malignancy, and the patient was finally diagnosed with sarcoidosis complicated with pleural effusion. Treatment with prednisone combined with therapeutic thoracentesis was initiated to relieve symptoms. Chylothorax developed on hospital day 22, and a low-fat diet was added to the treatment regimen; however, 20 days after therapy initiation, the persistent chylothorax showed no notable improvement. Following multidisciplinary consultation, methotrexate was added as adjuvant therapy to control sarcoidosis activity. The patient's symptoms then improved, and the patient was discharged on hospital day 49 with oral medications. Clinical remission was achieved at the 3-month follow-up; however, new tuberculous lesions were identified in the left lung at the 6-month follow-up. Methotrexate was discontinued immediately, prednisone was gradually tapered to a maintenance dose, and standardized anti-tuberculosis therapy was initiated. At the 12-month follow-up, pulmonary tuberculosis had achieved clinical cure following a 6-month course of treatment. Anti-tuberculosis therapy was continued for an additional 3 months as consolidation treatment before discontinuation, whereas maintenance-dose prednisone was continued to control the underlying sarcoidosis. No evidence of sarcoidosis or tuberculosis recurrence was identified at the 25- or 39-month follow-up. Prednisone was gradually tapered and ultimately withdrawn, and the patient achieved a favorable long-term outcome. The present case report describes a patient with sarcoidosis-associated chylothorax who developed new-onset pulmonary tuberculosis during immunosuppressive treatment, highlighting the challenges associated with the differential diagnosis and clinical management of complicated sarcoidosis. Although combination therapy with prednisone and methotrexate was temporally associated with improvement of the chylothorax, clinicians should remain aware regarding the risk of opportunistic infections.

In this phase II trial, we evaluated the addition of the CD3xCD20 bispecific antibody, glofitamab (glofit) to polatuzumab, rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) and an international prognostic index (IPI) [3] 2. Patients received two cycles of pola-R-CHP (one cycle of R-CHOP allowed). Glofitamab was added to pola-R-CHP during cycles 3 through 6 and used as monotherapy for cycles 7 and 8. The primary objective was the best complete response (CR) rate. A total of 41 patients enrolled. The median age was 61 years (range 35-86), and 59% were male. IPI scores were 2 (39%), 3 (41%), and 4 (20%), and 86% of patients had stage III/IV disease. Most patients had DLBCL, NOS (78%) and 12% had high grade B-cell lymphoma with translocations in MYC and BCL-2 and/or BCL-6. The best CR rate was 95% (39/41) (95% CI: 83-99) and both patients with a partial response at the end of therapy converted to CR without intervention. With a median follow-up of 23.9 months, the median progression-free survival (PFS) has not been reached and the 24-month PFS was 95% (95% CI: 89-100). Four (10%) patients developed cytokine release syndrome (CRS) (all grade 1), and no immune effector cell-associated neurotoxicity syndrome (ICANS) was reported. Glofit-pola-R-CHP resulted in high rates of CR and preliminary evidence of durable responses and the schedule, with delayed incorporation of glofit, resulted in low rates of CRS and no neurotoxicity. These data support further evaluation of this regimen. NCT05800366.