Overlap syndrome of systemic sclerosis and idiopathic inflammatory myopathies is an increasingly frequent entity, but the association with immune-mediated necrotizing myositis has rarely been described. While myositis or myopathy may be features of scleroderma, it is imperative to correctly diagnose an overlap syndrome of these two, since it can be considered a different entity with specific management and a worse prognosis. Anti-signal recognition particle (anti-SRP) antibodies target the striated muscle fiber and inhibit myoblast regeneration, resulting in myofiber atrophy and necrosis. Anti-SRP antibodies are specific in immune-mediated necrotizing myopathy characterized by myonecrosis and minimal inflammatory reaction, with proximal muscle weakness and typical extra-muscular manifestation. There are controversial data on the association of cardiac manifestations and the presence of these antibodies, and recent studies cannot prove a significant correlation between the two. Myocarditis is a complication with an unpredictable, potentially severe outcome from heart failure and dilated cardiomyopathy to fatality. It can be difficult to diagnose, and a myocardial biopsy can be problematic in daily practice; thus, most practitioners rely on cardiac magnetic resonance with suggestive images for the correct diagnosis. This paper seeks to address the challenges associated with the diagnosis and treatment of collagen diseases by evaluating the role of anti-SRP antibodies in the pathogenesis of cardiac involvement.

English: Obliterative bronchiolitis is a rare and complex obstructive pulmonary disorder involving inflammatory and fibroproliferative changes of the small airways. We report three adult cases of idiopathic bronchiolitis obliterans diagnosed at the “Marius Nasta” Institute of Pulmonology, Bucharest, between 2016 and 2025. The patients, aged 30–68 years, presented with exertional dyspnoea and fatigue, and all exhibited severe obstructive ventilatory impairment with significant oxygen desaturation during the 6-min walk test. Diagnosis was confirmed by high-resolution inspiratory–expiratory computed tomography in two cases and by lung biopsy in one case. Treatment consisted of systemic and inhaled corticosteroids, with one patient also receiving longterm intermittent azithromycin therapy. Outcomes varied: two patients achieved relative clinical stability, while one experienced progressive respiratory decline leading to death. These cases illustrate the diagnostic and therapeutic challenges of idiopathic bronchiolitis obliterans and highlight its unpredictable course. Early recognition and individualised management are essential, but further research is needed to establish effective treatment strategies and improve prognosis.