Purpose: This study aimed to assess liver involvement and investigate its correlation with rapidly progressive interstitial lung disease (RP-ILD) and mortality in anti-melanoma differentiation-associated gene 5 antibody-positive (anti-MDA5 positive) DM patients. Patients and Methods: This retrospective study included 159 patients diagnosed with anti-MDA5 positive DM or anti-synthetase syndrome (ASyS). Clinical features and laboratory findings were compared between patients with anti-MDA5 positive DM and patients with ASyS. In the anti-MDA5 positive DM cohort, clinical features and laboratory findings between patients with liver involvement and without liver involvement were further compared. The effects of liver involvement on the overall survival (OS) and development of RP-ILD were also analyzed using Kaplan–Meier method and Cox regression analysis. Results: Levels of serum aspartate aminotransferase (AST), alanine transaminase (ALT), γ-glutamyl transferase (γGT) and alkaline phosphatase (ALP) were all significantly higher in patients with anti-MDA5 positive DM than those in patients with ASyS. In our cohort of anti-MDA5 positive DM patents, 31 patients (34.4%) were complicated with liver involvement. Survival analysis revealed that serum ferritin > 1030.0 ng/mL (p< 0.001), ALT > 103.0 U/l (p< 0.001), AST > 49.0 U/l (p< 0.001), γGT > 82.0 U/l (p< 0.001), ALP > 133.0 U/l (p< 0.001), lactate dehydrogenase (LDH)> 474.0 U/l (p< 0.001), plasma albumin (ALB) < 35.7 g/l (p< 0.001) and direct bilirubin (DBIL) > 2.80 μmol/l (p=0.002) predicted poor prognosis. The incidence of RP-ILD increased remarkably in patients with liver involvement compared to patients without liver involvement (58.1% vs 22.0%, p=0.001). Multivariate analysis revealed that elevated serum ALT level was an independent risk factor for mortality (HR 6.0, 95% CI 2.3, 16.2, p< 0.001) and RP-ILD (HR 5.9, 95% CI 2.2, 15.9, p< 0.001) in anti-MDA5 positive DM patents. Conclusion: Liver involvement is common in patients with anti-MDA5 positive DM. Elevated serum ALT level was an independent risk factor for RP-ILD and mortality in patients with anti-MDA5 positive DM.

Objectives: To analyze the kinetics of T-cell subsets and thymic function reconstitution after allogeneic hematopoietic stem cell transplantation (AHSCT); to determine whether sjTREC (signal joint TCR rearrangement excision circle) and CD31-positive recent thymic emigrant (CD31 + RTE) are correlated with acute graft versus host disease (aGVHD) or CMV (cytomegalovirus) viremia after AHSCT. Methods: Forty-nine patients who underwent AHSCT in our institution were prospectively enrolled. Periphery blood samples were collected before conditioning and at 1, 2, 3 months after AHSCT. T-cell subsets were analyzed with flow cytometry. Genomic DNA was purified from peripheral blood mononuclear cells (PBMCs), and sjTREC was quantified by real-time PCR. Impact of sjTREC and CD31 + RTE on aGVHD and CMV viremia was evaluated by univariate and multivariate Cox regression analyses. Results: The analyzed T-cell subsets and sjTREC of patients before AHSCT were all significantly lower than those of healthy donors (p < 0.05). sjTREC and CD31 + RTE were remarkably decreased in 3 months after AHSCT (p < 0.05). Patients with lower pre-transplantation sjTREC and CD31 + RTE level had higher incidence of CMV viremia after AHSCT (p < 0.05). sjTREC/10⁶ PBMCs was negatively correlated with aGVHD (p = 0.024). Conclusion: Thymic function was impaired before transplantation, and was consistently decreased in 3 months after AHSCT. Patients who had lower pre-transplantation sjTREC level were at high risk of aGVHD and CMV viremia after AHSCT, low pre-transplantation CD31 + RTE was correlated with CMV viremia after AHSCT.

Axial gout is an underrecognized manifestation of monosodium urate (MSU) crystal deposition and frequently mimics inflammatory, infectious, or mechanical spinal disorders, particularly without overt hyperuricaemia. We report a 29-year-old man with recurrent low back pain for over two years and recurrent nephrolithiasis who had undergone three extracorporeal shock wave lithotripsy sessions with only transient relief. Admission laboratory investigations showed normal serum urate (262 µmol/L, ~ 4.4 mg/dL) but markedly elevated C‑reactive protein (119 mg/L) and erythrocyte sedimentation rate (53 mm/h). Retrospective review of prior hospitalizations for ureteral stones revealed that routine serum urate measurements had never been elevated. Conventional imaging, including plain radiography and non‑contrast computed tomography, was inconclusive. Dual‑energy computed tomography (DECT) revealed MSU deposition in the L4/L5 and L5/S1 facet joints and sacral foramina, supporting the diagnosis of axial gout. The patient was treated with etoricoxib (60 mg daily) and febuxostat (20 mg daily). On telephone follow‑up on 27 May 2026 (the only follow‑up to date), he reported that the J stent had been removed and low back pain had completely resolved without recurrence. A single repeat laboratory test performed locally was reported as normal, though specific values were unavailable. A systematic literature review of 58 eligible articles revealed that the lumbar spine was most frequently involved (≈ 60%), DECT sensitivity ranged from 78% to 100%, and 77.5% of historically reported cases required surgical diagnosis, underscoring the underrecognition of axial gout in non-surgical settings. This case‑based review highlights that axial gout should be considered in young non‑hyperuricaemic patients with persistent axial pain, and that DECT is a valuable non‑invasive diagnostic tool when interpreted alongside clinical and laboratory features.