Autoimmune diseases (ADs) represent a heterogeneous group of disorders that affect specific target organs or multiple organ systems. These conditions share common immunopathogenic mechanisms (i.e., the autoimmune tautology), which explain the clinical similarities they have among them as well as their familial clustering (i.e., coaggregation). As part of the autoimmune tautology, the influence of environmental exposure on the risk of developing ADs is paramount (i.e., the autoimmune ecology). In fact, environment, more than genetics, shapes immune system. Autoimmune ecology is akin to exposome, that is all the exposures – internal and external – across the lifespan, interacting with hereditary factors (both genetics and epigenetics) to favor or protect against autoimmunity and its outcomes. Herein, we provide an overview of the autoimmune ecology, focusing on the immune response to environmental agents in general, and microbiota, cigarette smoking, alcohol and coffee consumption, socioeconomic status (SES), gender and sex hormones, vitamin D, organic solvents, and vaccines in particular. Inclusion of the autoimmune ecology in disease etiology and health will improve the way personalized medicine is currently conceived and applied.

Flow cytometry is a consistent method for identifying the presence of IgG, IgM, IgA immune complexes and C3d attached to erythrocytes and can be helpful for understanding the mechanisms involved in AIHA pathogenesis.

<p>We describe a case of Takayasu arteritis with unusual presentation, having chest pain as the main symptom and a<strong> </strong>nasal septal perforation as a rare complication, without upper and lower extremities, abdominal, neck or cerebral compromise. The patient, a 34 year-old male, previously healthy, presented with acute onset of chest pain, dyspnea and severe compromise of his functional status. Severe stenosis of pulmonary arteries and coronaries, as well as signs of aortitis were found in a CT angiography of the thorax, pulmonary angiography and right and left heart catheterization<strong>. </strong>Anti-neutrophil cytoplasmic antibodies were positive. The patient received 750 mg of Methylprednisolone and monthly bolus of Cyclophosphamide. Six months after the diagnosis, the patient developed a nasal septal perforation. This is the first reported case of Takayasu arteritis with rapidly progressing coronary disease as the only presentation, complicated by a nasal septal perforation. </p>