BACKGROUND:Numerous studies indicate potential role of vitamin D as an important factor in the development of many autoimmune diseases including systemic lupus erythematosus (SLE). Patients with SLE are especially prone to the development of vitamin D deficiency due to the nature of their illness.AIM:The aims of our study were to determine the prevalence of vitamin D insufficiency and deficiency in patients with SLE in Serbia, to identify clinical variables associated with vitamin D status and to examine the impact of vitamin D status on disease activity and presence of specific lupus autoantibodies.MATERIAL AND METHODS:The study included 46 patients with SLE. Serum 25(OH)D concentration was measured by electrohemiluminiscent immunoassay.RESULTS:The mean serum concentration of 25(OH)D was 11.9 ± 7.3 ng/ml. The prevalence of insufficiency was 32.6%, while the prevalence of deficiency was 67.4%. There was no association between vitamin D status and photosensitivity, skin lesions, arthritis and lupus nephritis. Vitamin D status was not associated with the presence of specific autoantibodies. There was no correlation between disease activity assessed by SLEDAI scale with the concentration of 25(OH)D. Patients who used vitamin D supplements and calcium did not have a significantly higher concentration of 25(OH)D.CONCLUSION:In conclusion, vitamin D deficiency is common in patients with SLE.

In differential diagnosis, Melkersson-Rosenthal syndrome diagnosis primarily refers to conditions of angioneurotic edema and hereditary angioedema, as well as granulomatous diseases such as sarcoidosis, tuberculosis and Chron's disease. It is necessary to follow-up these patients in view of monitoring the effects of the therapy and possible development of systemic granulomatous diseases.

This case alerts to the need of careful examination of patients with SLE, collection of adequate cultures and evaluation of predisposition towards infections, before the introduction of immunosuppressants due to potentially fatal infection.

Mixed cryoglobulinemia is the most prevalent extrahepatic manifestation of chronic HCV infection. It is usually a benign lymphoproliferative disorder which presents as vasculitis affecting different organs. Although life-threatening cryoglobulinemic vasculitis (CryoVas) is rare, it is sometimes the first and possibly lethal complication. Its treatment depends on the severity of vasculitis and can be challenging. High dose of corticosteroids, immunosuppressive agents and plasma exchange represent the first-line treatment, which should be followed by antiviral therapy. Rituximab is an effective and safe treatment option. However, the data about its use in life-threatening conditions are scarce. We report the case of a patient with severe, relapsing and life-threatening HCV-related CryoVas  resistant to standard therapy who had had an initial beneficial response to rituximab added to plasma exchange that was later compromised by the development of sepsis. We also review the literature and discuss manifestations and therapy of life-threatening Cryovas with focus on rituximab use.

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Vitamin D is a steroid hormone that in addition to its well known role in the metabolism of calcium and phosphorus exerts immunoregulatory properties. Data from animal studies and from prospective clinical trials on patients with rheumatoid arthritis, multiple sclerosis and type 1 diabetes point to the potential role of vitamin D as important environmental factor in the development of autoimmune diseases. Such role of vitamin D in systemic lupus erythematosus (SLE) has not yet been sufficiently studied. This review shows the sources, metabolism and mechanism of action of vitamin D, its effect on the cells of the immune system, prevalence and causes of vitamin D deficiency in patients with SLE, the link between vitamin D status and disease activity as well as recommendations for vitamin D supplementation

Sjögren’s syndrome is an autoimmune disease of unknown etiology where immune response to self-antigens is believed to result from interactions between genetic and environmental factors. We describe the case of a patient who has been diagnosed with Sjögren’s syndrome based on typical clinical and immunological parameters. The clinical picture was dominated by the respiratory symptoms, and radiographic and multislice computed tomography examination of the chest showed certain changes characteristic of pneumoconiosis. Given that the patient has worked in a foundry where he has been exposed to the silica dust, he was subject to examination by occupational health specialists under the suspicion of lung silicosis, who confirmed the silicosis. This case report points to the possible connection between a professional exposure to silica and Sjögren’s syndrome. Occupational exposure to silica is a possible risk factor for the development of autoimmune diseases, and in the evaluation of patients with connective tissue diseases it is important to consider work-related history.

Introduction. Wegeners?s granulomatosis is a disease characterized by granulomatous inflammation of the upper and/or lower respiratory tract, glomerulonephritis with varying degrees of small vessel vasculitis and classic anti-neutrophil cytoplasmic antibodies (c-ANCA) findings. The treatment uses different modalities of immunosuppressive therapy which does not always lead to remission. We presented the efficacy of biological therapy in a patient with refractory form of the Wegeners?s granulomatosis. Case report. A 23-years-old patient, was treated in August, 2011 at the Clinic of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Center of Serbia because of suppurative otitis media, resulting twice in mastoidectomy. On the day 7 after the surgery, hemoptysis and fever occurred. Considering lung x-ray that showed presence of the round soft-tissue changes on both sides, nonspecific inflammatory syndrome in laboratory analysis and positive c-ANCA (1 : 160) with high titers the antibodies to the proteinase 3 (anti-PR 3), Wegener's granulomatosis was diagnosed. Due to the fact that administration of glucocorticoids, cyclophosphamide and immunomodulatory dose of immunoglobulin did not lead to clinical remission, it was decided to apply rituximab. After its application clinical remission occurred and it lasted fifteen months. Conclusion. Application of biologic therapy might be successful in the treatment of patients with severe form of refractory granulomatosis with polyangiitis.