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TNF-α antagonists are used to treat various rheumatic diseases including sarcoidosis. However, there have been increasing reports of sarcoidosis in relation to treatment using these drugs. The pathogenesis of this reaction remains unknown. This is a report of a clinical case of sarcoidosis in Behçet’s disease (DB) with mucocutaneous and intestinal involvement in treatment using adalimumab, with improvement after anti-TNF suspension and corticosteroid therapy. LEARNING POINTS This clinical case demonstrates the efficacy of the anti-TNFa adalimumab in the treatment of Behçet with intestinal manifestations and not responsive to other therapeutics. To our knowledge it is the first time it is described a case of sarcoid reaction in a patient with Behçet treated with adalimumab. It shows how two complications of the use of immunosuppressants (sarcoid reaction and Legionella pneumophila pneumonia) in the same patient can difficult the correct diagnosis because of the many and overlapping clinical manifestations.

We present a clinical case of a 75-year-old woman hospitalized for localized edema and erythema on the right hemiface, with progressive extension over 30 days. On objective examination, a heliotropic erythema, Gottron's papules and an ulcerated lesion on the right breast were founded. It's important to point out an increase of muscle enzymes in laboratory tests. According to classification criteria of the European League against Rheumatism, and taking into consideration the clinical suspicion of breast cancer, a paraneoplastic dermatomyositis was diagnosed. Highlight that dermatomyositis lesions are pathognomonic despite that they are not always recognized in the patient's first approach.

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Background Community-acquired pneumonia remains a significant factor in global mortality. Several clinical scoring models are used for predicting pneumonia severity and mortality, aiding in the clinical decision relative to the therapeutic approach, including the CURB-65 score. However, currently, no models exist to identify high-risk patients relative to long-term prognosis when recent evidence reveals a significantly higher mortality rate in the first year after community-acquired pneumonia (CAP) hospitalization. Purpose of the study The purpose of this study is to evaluate the application of the CURB-65 scoring model in our population and examine its potential to predict prognosis and subsequent mortality 6 months after hospitalization. Other potential factors influencing mortality during and after hospitalization were characterized: patient demographics, nosocomial infections, readmissions, and identified pathogens. Study design We conducted a retrospective observational study, enrolling 130 patients admitted with a diagnosis of CAP in the department of internal medicine of Centro Hospitalar Universitário Cova da Beira between January and December of 2018. Consultation of electronic medical records was used to calculate the CURB-65 score on admission at the first hospitalization by CAP, categorizing patients into five risk groups. Mortality and readmission were evaluated after 30, 90, and 180 days. Key results High-risk patients (CURB>2) accounted for 96.9% of our study population. Inpatient mortality of 13%, increasing to 21.5% after six months, was similar to previous studies and was correlated to the CURB-65 score on admission. A microbiologic agent was identified in 37% of cases, with 53% isolates of Streptococcus (S.) pneumoniae. Conclusions Identifying high-risk patients is important for more individualized healthcare and management. The CURB-65 score, only validated for a short-term (30 days) prediction, demonstrates a potential to also predict mortality and rehospitalization in the six-month period after hospitalization, as supported by our findings and previous studies.

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