Lupus erythematosus panniculitis (LEP) is a rare form of chronic cutaneous lupus involving the subcutaneous fat. Ulcerative lesions are uncommon and may mimic infectious, inflammatory, or neoplastic disorders, leading to delayed diagnosis. We report the case of a 40-year-old woman with longstanding photosensitivity who presented with a painful left gluteal ulcer evolving over eight months. The lesion began as a deep inflammatory nodule and progressively ulcerated. Antibiotic therapy was ineffective. Laboratory tests showed positive antinuclear antibodies at 1:160 and positive anti-Sm/RNP antibodies, with negative anti-double-stranded DNA antibodies. Histopathology revealed lymphocytic lobular panniculitis consistent with lupus panniculitis. Treatment with hydroxychloroquine and systemic corticosteroids resulted in partial improvement, but relapses occurred during steroid tapering. Dapsone failed to control the disease. Methotrexate was subsequently introduced, leading to marked clinical improvement within three months. This case highlights an unusual ulcerative gluteal presentation of lupus panniculitis. Early biopsy and clinicopathological correlation are essential to exclude mimickers and guide appropriate immunomodulatory treatment.

The application of full-length antibodies as radioimmunoconjugates necessitates a prolonged period between administration and imaging to achieve optimal target visualization. Transcyclooctene-tetrazine chemistry, which enables displacement of radioisotopes from immunoconjugates, can enhance in vivo imaging of target signal relative to background through rapid clearance of circulating, nontargeted radioactivity. An alternative approach, which may accelerate clinical translation, repurposes recombinant enzymes that are approved by the Food and Drug Administration for therapeutic use to trigger cleavage of radioimmunoconjugate linkers. Methods: Radioimmunoconjugate linkers cleavable by β-glucuronidase, carboxypeptidase G2, and tissue plasminogen activator were designed, synthesized, and conjugated to the CD20-targeting antibody rituximab using NOTA or desferrioxamine (DFO) to chelate [68]Ga or [89]Zr. CD20-positive Raji cells were incubated with radioimmunoconjugate followed by a cleaving enzyme. Radioimmunoconjugate uptake was measured in CD20-positive Raji cells to confirm immunoreactivity and accumulation in target cells. Biodistribution studies were performed in healthy mice after administration of radioimmunoconjugate and either cognate enzyme or saline to quantify the clearance of radioactivity from the circulation. [[89]Zr]DFO-methotrexate-rituximab was administered to CD1 nude mice carrying subcutaneous Raji xenografts, followed by carboxypeptidase G2 or saline, with subsequent PET imaging and biodistribution studies performed to assess enzyme-mediated changes in imaging contrast. Results: Radioimmunoconjugates were successfully prepared with greater than 95% radiochemical purity. In vitro uptake studies in Raji cells confirmed internalization of radioimmunoconjugates after antigen binding. After internalization, radioimmunoconjugates were no longer susceptible to enzymatic cleavage. Intravenous administration of carboxypeptidase G2 and β-glucuronidase cleared approximately 50% and 70% of injected radioactivity, respectively, from the circulation of non-tumor-bearing mice. In immunocompromised mice bearing subcutaneous Raji xenografts, administration of [[89]Zr]DFO-MTX-rituximab followed by carboxypeptidase G2 enhanced the tumor-to-blood imaging signal by greater than 40% compared with saline-treated controls. Conclusion: The use of Food and Drug Administration-approved enzymes to clear radioactivity from circulating radioimmunoconjugates showed significant efficacy in vivo, providing proof of concept for future clinical applications, particularly in hematologic malignancies.

Importance: Dermatologic and psychotropic therapies intersect frequently in patients with bipolar disorder, in whom systemic dermatologic medications may affect mood stability and mood stabilizers or antipsychotics may produce clinically important cutaneous adverse reactions. Because several medications discussed in this review are also used for psychotic disorders, severe or treatment-resistant major depressive disorder, suicidality, and other psychiatric conditions, this article distinguishes medication-related risks from considerations specific to bipolar disorder.

Interstitial pregnancy (IP) is an ectopic pregnancy in the segment of the fallopian tube within the muscular wall of the uterus. Due to its rarity, the applicability and safety of systemic methotrexate (MTX) administration for IP remain unclear, especially when the mass is relatively large. We encountered a 21-year-old patient who was diagnosed with an asymptomatic IP of 42 mm × 52 mm and beta-human chorionic gonadotropin (β-hCG) of 7,640 mIU/ml. A single dose of systemic MTX at 50 mg/m2 gradually decreased her β-hCG levels, which became undetectable 161 days after treatment; however, the remnant mass persisted. On further follow-up, the mass disappeared 21 months after MTX administration. Our clinical experience suggests that MTX can be considered for large IPs (>4 cm) if the patient is asymptomatic and hemodynamically stable, and that remnant tissue should be recognized as an unignorable complication of MTX treatment for IPs requiring long-term follow-up.

Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a rare but relevant complication of long-term methotrexate (MTX) therapy that can closely mimic infection or disseminated malignancy. We report the case of a 65-year-old woman with a 10-year history of systemic lupus erythematosus (SLE) treated with MTX, who presented with progressive back pain, constitutional symptoms, pancytopenia, and extensive multiorgan disease. Fluorodeoxyglucose positron emission tomography (FDG PET) demonstrated widespread hypermetabolic lesions involving the lungs, liver, left adrenal gland, and skeleton, raising strong suspicion of disseminated metastatic malignancy. Two ultrasound-guided liver nodule biopsies were inconclusive, with no evidence of malignancy. Given the absence of histopathological confirmation and her prolonged MTX exposure, MTX-LPD was suspected, and MTX was discontinued. No oncologic treatment was initiated. Four months later, the patient had achieved complete clinical resolution of her symptoms, and follow-up imaging showed near-complete regression of the pulmonary, hepatic, adrenal, and most skeletal lesions.

Nitazoxanide (NTZ), an FDA-approved anti-parasitic drug, has shown anti-inflammatory effects in rheumatoid arthritis (RA) fibroblast-like synoviocytes, yet its impact on immune cell function and its potential synergy with methotrexate (MTX) remains unclear. In this study, using a murine collagen-induced arthritis (CIA) model, we demonstrated that NTZ synergizes with MTX to delay arthritis onset and ameliorate joint pathology, accompanied by reduced inflammatory cell infiltration, synovial pannus formation, and bone destruction. Moreover, NTZ significantly suppressed inflammatory cytokine production in both murine splenocytes and human peripheral blood mononuclear cells from healthy donors and RA patients. In vivo findings from the CIA model further demonstrated that NTZ suppressed synovial IL-6 and pSTAT3 expression, as well as Th17 cell differentiation. And these effects collectively contributed to the improvement in arthritis score. Mechanistically, NTZ markedly inhibited the STAT3 signaling pathway in immune cells upon IL-6 or anti-CD3 stimulation. Additionally, it potently suppressed osteoclast differentiation of monocytes derived from RA patients. Taken together, this study provides a proof-of-concept for NTZ's immunomodulatory activity in RA, yet the data remain insufficient for therapeutic claims and only lay the groundwork for further studies.

Facial vitiligo affects a substantial proportion of patients with vitiligo and is associated with significant psychosocial burden due to its visibility. Facial vitiligo is primarily classified into nonsegmental and segmental subtypes, each with distinct distribution patterns and prognostic features. Nonsegmental vitiligo is further divided into 3 morphological patterns-centrofacial, panfacial, and hairline-each with unique clinical characteristics and treatment responses. The pathogenesis is multifactorial, involving genetic susceptibility, oxidative stress, and autoimmune destruction of melanocytes. Diagnosis is primarily clinical, supported by Wood lamp examination, dermoscopy, and advanced imaging techniques. First-line treatment includes topical calcineurin inhibitors and ruxolitinib, often combined with phototherapy to maximize repigmentation. The 308-nm excimer laser offers targeted delivery of ultraviolet (UV) radiation, minimizing photodamage to uninvolved skin. For progressive disease, systemic corticosteroids are commonly used for stabilization, with methotrexate, cyclosporine, or azathioprine as alternatives. Surgical interventions, particularly micropunch grafting, are effective options for stable, treatment-refractory cases. Emerging therapies, including oral Janus kinase inhibitors and biologics targeting tissue-resident memory T cells, are under investigation with encouraging preliminary results. Lifestyle modifications, including avoidance of mechanical friction, UV protection, and antioxidant-rich dietary patterns, may serve as supportive adjuncts to medical therapy. Recognizing the clinical heterogeneity of facial vitiligo, this review highlights the necessity of individualized treatment strategies based on clinical phenotypes to optimize therapeutic outcomes and improve quality of life.