Chronic pulmonary aspergillosis (CPA) is a chronic progressive lung disease associated with a poor prognosis and a 5-year mortality rate of approximately 40–50%. The disease is characterized by slowly progressive destruction of the lung parenchyma, in the form of multiple cavities, nodules, infiltrates or fibrosis. CPA can be challenging to diagnose due to its non-specific symptoms and similarities with other respiratory conditions combined with the poor awareness of the medical community about the disease. This can result in delayed treatment even for years and worsening of the patient’s condition. Serological tests certainly play a significant role in diagnosing CPA but cannot be interpreted without radiological confirmation of CPA. Although many data are published on this hot topic, there is yet no single definitive test for diagnosing CPA, and a multidisciplinary approach which involves a combination of clinical picture, radiological findings, microbiological results and exclusion of other mimicking diseases, is essential for the accurate diagnosis of CPA.

Macrophage activation syndrome (MAS) is a complex, life-threatening, hyperinflammatory condition occurring as a form of hemophagocytic lymphohistiocytosis (HLH), commonly associated with several autoimmune and autoinflammatory diseases, and certain infections such as Parvovirus B19 (P19V). The onset of systemic lupus erythematosus (SLE) presenting as MAS during pregnancy is uncommon, posing significant diagnostic and therapeutic challenges. We present a case of a 30-year-old woman at the 12th gestational week with fever, arthralgia, rash, cervical lymphadenopathy, cytopenia, and elevated liver enzyme. Bone marrow biopsy revealing hemophagocytosis, elevated ferritin and triglycerides, high interleukin-2, fever and cytopenia, confirmed the diagnosis of HLH. Further evaluation revealed the diagnosis of SLE. Treatment was initiated with intravenous immunoglobulin and corticosteroids. Given the deterioration in the patient’s clinical condition, a decision was made to terminate the pregnancy. She continued in the following months to receive SLE treatment with corticosteroids, cyclophosphamide, hydroxychloroquine, and later with mycophenolate mofetil due to the development of Class IV of lupus nephritis. P19V IgM antibodies were initially positive, later seroconverted to IgG, indicating that infection may have acted as a trigger for the onset of SLE and MAS development during pregnancy. The overlapping clinical features of P19V infection, SLE, and MAS pose significant diagnostic and therapeutic challenges. Early recognition and comprehensive diagnostic evaluation are crucial for the management of these conditions, especially during pregnancy, where both maternal outcomes are at risk.

Background: Takayasu arteritis (TA) is a large-vessel vasculitis with an incompletely understood pathogenesis, in which genetic factors are thought to play an important role. Cytokine-mediated immune pathways, particularly those involving Th1 and Th17 responses, have been implicated in the immunopathogenesis of TA, making cytokine gene polymorphisms plausible genetic susceptibility markers. Methods: Functional single-nucleotide polymorphisms in selected cytokine- and receptor-encoding genes (IL12B, IL23R, IL6, TNF, IL10, and CSF2) were analyzed in 33 patients with TA and 486 healthy Serbian controls using TaqMan genotyping assays. Allele and genotype frequencies were compared between groups. Results: A nominally significant association was observed only for IL12B rs3212227. The T allele and TT genotype were less frequent in patients compared with controls (71.21% vs. 82.02%, p = 0.037; 48.48% vs. 66.67%, p = 0.041, respectively), suggesting a potential protective effect. No significant associations were detected for polymorphisms in IL23R, IL6, TNF, IL10, or CSF2. Conclusions: Our findings support the potential role of IL12B in genetic susceptibility to Takayasu arteritis, while other examined cytokine gene polymorphisms showed no statistically significant association. These results highlight the importance of the IL-12/IL-23 axis in disease pathogenesis and suggest possible population-specific genetic effects. Further studies in larger and independent cohorts are warranted to validate these findings.

Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis affecting predominantly small vessels, typically associated with PR3-ANCA positivity. Central nervous system involvement beyond cranial nerve palsies is rare, with intracerebral granulomas being exceptionally rare and lacking specific imaging characteristics, often mimicking malignancies or other intracranial pathologies. This significantly complicates the diagnostic process, particularly in the absence of active systemic disease. We report a case of a 71-year-old woman in whom neurological symptoms and magnetic resonance imaging revealed intracerebral granulomas and led to the diagnosis of GPA. Early recognition of tumor-like brain lesions in GPA and prompt initiation of immunosuppressive and anti-edematous therapy are crucial to prevent progression and potentially life-threatening compressive complications.