Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most globally prevalent chronic liver disorder. Thus, this study aimed to evaluate the association of serum endocan and endoglin levels with fibrosis severity in patients with MASLD. In the study, between December 2023 and November 2024, 58 MASLD patients and 30 healthy controls were enrolled; sample size was based on a power analysis. Vibration-controlled transient elastography, reporting controlled attenuation parameter, and liver stiffness in kilopascals was used to quantify hepatic steatosis and fibrosis, and serum endocan and endoglin levels were measured. Comparisons were made between the MASLD and control groups, and within the MASLD group between patients with advanced-stage fibrosis versus those with lower-stage fibrosis. Discriminative ability of the biomarkers was evaluated by receiver operating characteristic (ROC) analysis. Independent associations between serum biomarkers and kilopascals values in the patient group were assessed by regression analysis. Serum endocan and endoglin were significantly elevated in the MASLD group compared with controls. In the MASLD group, patients with advanced fibrosis exhibited higher endocan and endoglin levels than those with lower-stage fibrosis. In ROC analysis for discriminating advanced fibrosis, endoglin demonstrated strong discriminative ability and endocan exhibited good accuracy for fibrosis assessment. Multivariate regression analysis revealed that log-transformed kilopascals values were independently associated with serum endocan and endoglin. Endoglin and endocan are promising, accessible noninvasive biomarkers that may support fibrosis triage and referral decisions in general internal medicine for MASLD. Prospective validation is warranted.

Azathioprine (AZA) is a widely prescribed immunosuppressive agent in the long-term management of autoimmune hepatitis (AIH), valued for its steroid-sparing properties and efficacy in maintaining disease remission. While its common adverse effects – such as myelosuppression, hepatotoxicity, and gastrointestinal intolerance – are well-recognized and routinely monitored, hypersensitivity pneumonitis (HP) remains an exceptionally rare but potentially life-threatening complication. Herein, we describe a 21-year-old female patient with AIH diagnosed at age 18. Who developed possible AZA-induced HP during the 3rd year of continuous therapy. We discuss the potential immunopathogenic mechanisms, review the limited literature on AZA-related pulmonary toxicity, and emphasize the importance of early recognition to prevent irreversible lung injury and optimize patient outcomes.

Introduction: Mesalazine is a cornerstone therapy for ulcerative colitis (UC). Although generally safe, it can cause rare but life-threatening cardiopulmonary complications such as pleuropericarditis. Case description: We report on a patient with a UC flare who presented with dyspnoea, where concurrent pericardial and pleural effusions were detected. The inflammatory response was likely suppressed by concomitant corticosteroid therapy, which masked the clinical manifestations of mesalazine-induced serositis and delayed diagnosis. Two years later, the patient re-presented with recurrent massive pericardial effusion causing tamponade physiology and pleural effusion. Pericardial fluid analysis revealed a haemorrhagic, neutrophil-dominant profile (95% polymorphonuclear leukocyte, mimicking bacterial infection rather than the typically described eosinophilic pattern. Extensive cultures were negative. Following the discontinuation of mesalazine, rapid clinical and radiologic improvement was observed, confirming drug-induced pleuropericarditis. Discussion: This case highlights that mesalazine-associated pleuropericarditis can be obscured by corticosteroids, leading to diagnostic delays. Furthermore, sterile inflammatory reactions to mesalazine can present with atypical neutrophilic features resembling bacterial infection, necessitating a high index of suspicion in inflammatory bowel disease patients presenting with serositis.