The coexistence of systemic sclerosis and sarcoidosis is very rare. Both are systemic autoimmune diseases with lung involvement but different pathogenesis. In contrast to findings of mid- to upper-lobe interstitial lung disease (ILD) that may occur with hilar lymphadenopathy in sarcoidosis, the most common lung manifestation of systemic sclerosis is lower-lobe ILD, which is typically characterized by a non-specific interstitial pneumonia pattern. This distinction in lung involvement between the two diseases is crucial due to the need for different therapeutic approaches. We present a series of three overlap cases: two with sarcoidosis onset before the diagnosis of systemic sclerosis and another with systemic sclerosis onset before the diagnosis of sarcoidosis. Three cases of concomitant sarcoidosis and systemic sclerosis are reviewed, including the pathophysiology of each disease and the shared pathways leading to the development of both conditions. Systemic sclerosis-sarcoidosis overlap is a high-risk phenotype. Early recognition and a personalized, aggressive therapeutic approach are essential to alter the natural course of these two converging fibrotic and granulomatous processes.

Immunoglobulin G4-related mastitis (IgG4-RM) represents localized form of IgG4-related disease (IgG4-RD), an immune-driven condition marked by abnormal infiltration of plasma cells and raised IgG4 levels. Breast involvement is exceedingly rare and often misinterpreted as malignancy. We report a case of a 40-year-old woman presenting with right axillary lymphadenopathy and clinical suspicion of occult breast malignancy. Contrast-enhanced mammography (CEM) revealed multiple small, equal-density, microlobulated masses in both breasts, exhibiting moderate heterogeneous enhancement. The findings and pattern of involvement favored a secondary breast involvement rather than primary malignancy. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography demonstrated FDG-avid lesions in the breasts, liver, and spleen, pointing toward systemic immune-mediated pathology. Core biopsy from the breast confirmed IgG4-RM. The patient responded extremely well to oral corticosteroids. This case highlights the diagnostic challenges of IgG4-RM and underscores the critical role of radiologic-pathologic correlation. To the best of our knowledge, this case is the first report in the literature to illustrate the CEM features of IgG4-RM, offering novel imaging insights into this underrecognized entity.

Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting necrotizing lymphadenitis that can mimic infection, malignancy, or autoimmune disease. Its coexistence with systemic lupus erythematosus (SLE) and macrophage activation syndrome (MAS) is uncommon and presents significant diagnostic challenges. We report a 15-year-old boy who presented with prolonged fever, generalized lymphadenopathy, cytopenias, oral ulcers, myositis, and acute pancreatitis. Laboratory evaluation revealed positive antinuclear and anti-Smith antibodies, hypocomplementemia, markedly elevated serum ferritin levels (27,650 ng/mL), hypertriglyceridemia, and hypofibrinogenemia. Lymph node biopsy demonstrated histiocytic necrotizing lymphadenitis consistent with KFD. The patient fulfilled the diagnostic criteria for SLE complicated by MAS and acute pancreatitis. Early initiation of high-dose corticosteroids, intravenous immunoglobulin, cyclophosphamide, cyclosporine, and hydroxychloroquine resulted in clinical and biochemical remission. This case highlights the importance of recognizing KFD-SLE overlap with MAS in adolescents presenting with persistent fever and cytopenias, as prompt immunosuppressive therapy can be life-saving.

Syphilis, a sexually transmitted infection caused by Treponema pallidum, continues to represent an important public health challenge worldwide, especially in underserved and resource-limited settings. We report a 65-year-old man from a rural area who presented with progressive weight loss, malaise, generalized lymphadenopathy, and a trunk rash, features that can mimic HIV, tuberculosis, viral infections, or lymphoma. A rapid HIV/Syphilis Duo test (SD BIOLINE, Standard Diagnostics Inc., South Korea) was reactive for syphilis and negative for HIV, but no nontreponemal or confirmatory assays were available. According to international guidelines, accurate diagnosis requires both treponemal and nontreponemal testing, yet in rural settings, clinicians often must act on incomplete data. Based on the clinical findings and reactive treponemal test, a presumptive diagnosis of secondary syphilis was made, and benzathine penicillin G 2.4 million units intramuscularly was administered. This case highlights the diagnostic and management challenges faced in resource-limited environments, where overlapping clinical features, incomplete diagnostic algorithms, and restricted access to treatment and follow-up increase the risk of persistent infection and continued transmission.

The best tissue sample is still very important for the diagnosis of mesothorax lymphadenopathy. In the past 20 years endobronchial ultrasound (EBUS) has been used efficiently in most cases of primary lung cancer disease or metastatic disease. Several new type of needles have been created such 19G, 18G and hybrid biopsies with cryoprobes. Rapid on-site evaluation (ROSE) is used as an additional initial diagnostic tool. Confocal microscopy is a method of rapid on-site evaluation.

We report the case of a man in his 30s who presented with exertional dyspnoea and dry cough for 18 months, along with fever and generalised lymphadenopathy (cervical and axillary) for 3 months. He had no feature indicating a connective tissue disorder. High-resolution CT of the chest revealed bilateral and diffuse thin-walled cysts with multiple mediastinal lymph nodes, consistent with a cystic interstitial lung disease. His pulmonary function test showed a severe restrictive disease and an autoimmune workup revealed strong positivity for anti-SSA/Ro52. Minor salivary gland biopsy showed lymphocytic foci with a focus score of >1. Based on the 2016 American College of Rheumatology-European Alliance of Associations for Rheumatology (ACR-EULAR) classification, the patients' diagnosis of Primary Sjögren's was confirmed. A transbronchial lung biopsy on histopathology showed diffuse polyclonal lymphoplasmacytic interstitial infiltration with germinal centre formation, consistent with lymphocytic interstitial pneumonia. In view of the extensive lymphadenopathy, lymphoma was systematically ruled out through lymph node excision, bone marrow examination and serum electrophoresis, all of which supported a benign reactive process. The patient was diagnosed with lymphocytic interstitial pneumonia and pseudolymphomatous lymphadenopathy as the initial manifestation of primary Sjögren's syndrome and showed clinical stability following treatment with systemic corticosteroids and mycophenolate mofetil.

The true burden of dengue on the African continent is likely underestimated, with approximately 80% of confirmed cases originating from West Africa. In this report, we describe for the first time two imported mild dengue cases detected in travelers returning to Rwanda from Brazil and the Central African Republic. The first case involved a 58-year-old woman from Uganda traveling through Rwanda to Brazil, who presented with fever and lymphadenopathy on June 2, 2024. The second case was a 32-year-old man from Kicukiro District, who sought medical care on September 26, 2024 and exhibited fever and general weakness after visiting the Central African Republic. The traveler from Brazil was infected with dengue virus (DENV)-1, whereas the traveler from Central Africa carried DENV-2. This report underscores the growing risk of dengue being introduced into Rwanda through international travel and highlights the critical need to establish robust cross-border surveillance systems. It calls for improved early detection, active vector monitoring, and the enhancement of national and regional response strategies in line with the International Health Regulations.