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Myelodysplastic syndromes (MDS) and Acute Myeloid Leukemia (AML) are increasingly recognized to exhibit immune dysregulation, which can occasionally present with autoinflammatory manifestations. We describe four patients with MDS/AML harboring p53 mutations and a complex karyotype who developed inflammatory serositis without infectious correlation. All patients showed clinical improvement following corticosteroid therapy.

Chronic graft-versus-host disease (cGVHD)-related serositis is rare, and primarily presents as polyserous effusions. The low incidence and differential diagnosis impose significant challenges to the prompt diagnosis and the effective treatment of the disease. Here we report the diagnosis and treatment of a 57-year-old woman who experienced recurrent steroid-refractory cGVHD-related serositis after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We thus added baricitinib, a specific JAK1/2 inhibitor, into the treatment regimen for the recurrent disease. The patient’s clinical symptoms and effusions were effectively relieved. Currently, no recurrence of serositis and significant adverse events were observed. The utilization of baricitinib might emerge as a novel promising therapeutic option for the treatment of steroid-refractory GVHD following allo-HSCT.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multi-organ inflammation and damage across multiple organs, typically managed with steroids and immunomodulators. However, prolonged use of these treatments is often associated with significant side effects, underscoring the need for adjunctive therapies that improve disease outcomes while minimizing adverse effects. Molecular hydrogen (H ) has demonstrated potential as an antioxidant and anti-inflammatory agent. This report discusses a case of SLE with cardiac complications, evaluating the therapeutic impact of molecular hydrogen therapy on fatigue, immune modulation, and cardiac function. A 51-year-old female with SLE and acute decompensated heart failure initially received steroids and immunomodulators for disease management. Subsequently, molecular hydrogen therapy was introduced as an adjuvant treatment. Over several months, her cardiac function showed notable improvement, evidenced by reductions in anti-dsDNA and anti-Ro52 antibody levels, and Pro-BNP levels, as well as favorable shifts in T and B cell subsets. Additionally, the patient experienced a significant reduction in fatigue. She successfully tapered off steroids while maintaining disease stability with ongoing molecular hydrogen therapy. This case highlights the potential of molecular hydrogen therapy as an adjuvant treatment in SLE, with observed benefits in immune modulation and fatigue reduction. Further studies are warranted to elucidate its therapeutic role and applicability in autoimmune diseases.

Diagnosis of tuberculous serositis remains a challenge. The aim of this study was to evaluate the diagnostic efficiency of T-SPOT.TB on serous effusion mononuclear cells (SEMC) for diagnosing tuberculous serositis in a high TB burden area. The present prospective study enrolled patients with suspected tuberculous serositis in a tertiary referral hospital in Beijing, China, to investigate the diagnostic sensitivity, specificity, predictive value (PV), and likelihood ratio(LR) of these tests. Clinical assessment, T-SPOT.TB on SEMC, and T-SPOT.TB on PBMC were performed. Test results were compared with the final confirmed diagnosis. Of the 187 participants, 74 (39.6%) were microbiologically or clinically diagnosed as tuberculous serositis and 93(49.7%) were ruled out. The remaining 20 (10.7%) patients were clinically indeterminate and excluded from the final analysis. Compared to that on PBMC, T-SPOT.TB on SEMC showed higher sensitivity (91.9%vs73.0%, P = 0.002), specificity (87.1%vs.73.1%, P = 0.017), PPV (85.0%vs.68.4%, P = 0.013), NPV (93.1%vs.77.3%, P = 0.003), LR+ (7.12vs.2.72) and LR- (0.09vs.0.37), respectively. The frequencies of spot forming cells (SFCs) for T-SPOT.TB on SEMC were 636 per million SEMC (IQR, 143-3443) in patients with tuberculous serositis, which were 4.6-fold (IQR, 1.3-14.3) higher than those of PBMC. By ROC curve analysis, a cut-off value of 56 SFCs per million SEMC for T-SPOT.TB on SEMC showed a sensitivity of 90.5% and specificity of 89.2% for the diagnosis of tuberculous serositis. T-SPOT.TB on SEMC could be an accurate diagnostic method for tuberculous serositis in TB endemic settings. And 56 SFCs per million SEMC might be the optimal cut-off value to diagnose tuberculous serositis.

BackgroundManagement of systemic lupus erythematosus (SLE) is largely guided by organ involvement. Serositis affects up to 46% of patients, yet its treatment is mainly empirical and extrapolated from other manifestations, and long-term outcome data remain limited. We aimed to evaluate short-term response to anti-inflammatory therapy and to examine associations between immunosuppressive treatments and serositis relapse.MethodsWe conducted a multicentre retrospective real-world study in patients with SLE with pericarditis and/or pleuritis, identified through a nationwide call for case reporting. Initial response was defined as symptom and sign resolution at early reassessment. Relapse was defined as recurrence requiring treatment intensification ≥3 months after the index flare. Relapse-free survival was described by Kaplan–Meier methods and analysed as recurrent events using a Prentice-Williams-Peterson gap-time Cox model adjusted for prespecified confounders.ResultsOne hundred patients contributed 180 serositis episodes (161 pericarditis, 51 pleuritis, associated in 32 cases) over a mean follow-up of 91 months; 46% experienced ≥1 relapse. Overall, 108/124 (87.1%) of evaluable episodes responded to initial anti-inflammatory therapy, with no significant difference between corticosteroid-based and aspirin/colchicine regimens. Corticosteroid use was not associated with increased relapse risk (46.0% vs 46.2%, p=0.98). Conventional immunosuppressants (methotrexate, azathioprine, mycophenolate mofetil) were not associated with reduced relapse risk, whereas belimumab was associated with lower relapse risk (HR=0.34, 95% CI 0.14 to 0.84; p=0.019).ConclusionLupus-related serositis is frequent and highly relapsing. In this national cohort, belimumab—but not conventional immunosuppressants—was associated with reduced serositis recurrence, supporting its further evaluation in lupus serositis.

We report an exceptional case of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) in a woman in her 70s presenting with extensive serositis, including pericardial, pleural and peritoneal effusions. Serositis is an unusual finding in RS3PE, and while a few cases with pleural or pericardial effusion have been described, the presence of ascites has not been previously reported in idiopathic RS3PE without associated malignancy. The patient exhibited classical features of RS3PE along with systemic inflammation and responded well to corticosteroids and methotrexate. This case expands the clinical spectrum of RS3PE and highlights the need to consider this diagnosis in elderly patients with unexplained polyserositis and inflammatory arthritis.

A definitive diagnosis of tuberculosis serositis (TS) is still challenging. Our preliminary practice found that Serous Fluid Drainage Flocky Precipitate (SFDFP) was a useful testing sample to diagnose TS. We designed this study to assess the diagnostic performance of SFDPF for TS compared with conventional bacteriology methods on serous fluid (SF). A cohort study was conducted from July 2014 to April 2016. Patients with suspected TS were consecutively screened. SF and SFDFP were collected and tested by Ziehl-Neelsen stain, MTB culture, and Xpert/RIF assay. We compared the diagnostic performance of SF and SFDFP in several test settings. Through this study, 85 patients were enrolled, of whom 70 (82.4%) were confirmed TS or highly probable TS, 13 (15.3%) were none-TS and 2 (2.4%) indeterminate results were ruled out. The overall sensitivity using both SFDFP and SF was significantly higher than each (60% vs. 48% and 41%, p < 0.05). SFDFP and SF samples had similar diagnostic performance (p < 0.05). No false positive was detected in this study. We concluded that SFDFP is a reliable testing sample for diagnosing tuberculous serositis. SFDFP may significantly improve the diagnostic yield as a supplement to conventional tests.

Serositis is a rare manifestation of chronic GvHD (cGvHD). No risk factors or laboratory changes associated with this syndrome have been recognized to date, and outcomes have not been described in a large series. We searched our institutional database for patients undergoing allogeneic hematopoietic cell transplant identified as having serositis or pericarditis. Laboratory studies from prior to diagnosis, at diagnosis and post diagnosis of serositis, as well as outcomes from invasive procedures were included. Twenty patients met criteria for cGvHD-associated serositis, and all but three patients had a prior diagnosis of cGvHD. Fifteen were male, and the complication occurred in the setting of immunosuppressant taper in 12 cases. Ten patients required invasive interventions, including pericardial window or stripping. A significant increase in blood monocytes and decrease in serum albumin were identified at diagnosis compared with pre-diagnosis. Out of 20 patients, 17 were treated with steroids, with 12 demonstrating a complete response. These data suggest that cGvHD-associated serositis occurs mainly in the setting of treated as opposed to de novo cGvHD and biomarkers associated with the syndrome include a decrease in albumin and an increase in absolute monocyte count. Outcome data from larger series are required to better understand the optimal management of this rare complication.

Detection of autoantibodies in systemic lupus erythematosus (SLE) plays an important role in timely diagnosis and earlier treatment of SLE. In this study, we used a SmD1 polypeptide-based ELISA to determine anti-SmD1 antibody in 269 SLE, including100 naïve (had not been treated with steroids or immunosuppressants at study inception) SLE patients and 169 non-naive SLE patients; 233 controls with other rheumatic diseases (RDC) (70 RA, 40 AS, 73SSc, and 50 SS), and 110 healthy controls (HC) group. The positive rate of anti-SmD1 among all SLE patients was 60.97%, higher than that in the RDC group (13.30%, P  = 0.000) or the HC group (9.09%, P  = 0.000). The positive rate of anti-SmD1 in non-naive SLE patients was higher than that for anti-dsDNA antibodies (44.97%, P  = 0.03). Positivity for anti-SmD1 only was found in 14.00% of naive SLE patients and 16.00% of non-naive SLE patients. In naive SLE patients, the serum concentration of anti-SmD1 was lower after treatment than before treatment ( P  = 0.039). Active SLE patients positive for anti-SmD1 were more likely to have malar rash, rash, nonscarring alopecia, PAH and hypocomplementemia. High positivity for anti-SmD1 only in patients with SLE indicated the importance and necessity of detection of anti-SmD1 in patients with SLE.