Gut microbiota (GM) is a complex microenvironment characterised by intricate interactions, which might play a pivotal role in the pathogenesis of many autoimmune diseases, including celiac disease (CD). DDysbiosis of gut bacteria can have a wide range of effects; however, whether it is a cause or a consequence of certain diseases and how it evolves during disease progression remains an area of active research. Celiac disease patients appear to have characteristic microbiota patterns, including low levels of beneficial species and high levels of potentially pathogenic species. The use of pro-, pre-, syn- and post-biotics to modulate the GM requires more systematic investigation, to determine the impact of specific species, the optimal dosage and the treatment duration needed to achieve desired results without adverse reactions. Additionally, osteoporosis in the course of CeD ease warrants further investigation. Many factors may contribute to its pathogenesis, including GM. This review summarizes recent literature concerning the role of GM in CeD, highlighting both consistent findings and areas of ongoing debate.

Agenesis of vena cava inferior (AVCI) is a rare congenital malformation with a prevalence of 0.0005–1% in the general population. High level of suspicion is required in young patients with deep vein thrombosis (DVT), particularly bilateral. We present an 8-year-old girl with AVCI presenting as bilateral lower extremity DVT and a review of the literature in pediatric cases with AVCI and DVT.

Stayroula Papailiou, Margarita Onoufriou, Lida Mentesidou, Angeliki Syggelou, Maria N Tsolia, Despoina N Maritsi; Achieving inactive disease in enthesitis-relat

Streptococcal toxic shock syndrome is a severe complication of group A streptococci. The production of antiphospholipid antibodies has been associated with streptococcal infections and with autoimmune diseases. Furthermore, streptococcal infections could be a trigger of Behcet's disease. We report a case of a boy who presented antiphospholipid syndrome after streptococcal toxic shock syndrome later he was diagnosed with Behcet's disease.

LER & CER: letter to Editor Rheumatology; Authors: D.N. Maritsi, L. Mentesidou, A. Syggelou, M.N. Tsolia