Lupus nephritis (LN) is a frequent and serious complication of systemic lupus erythematosus (SLE), impairing patients' quality of life and significantly increasing mortality. Despite optimizing the use of conventional immunosuppressants and other biological drugs, its management remains unsatisfactory. This is mainly due to the heterogeneity of SLE, but also to insufficiently effective treatment regimens and clinical trial limitations (strict criteria, low number of patients included, and side effects). Most clinical trials of new biological therapies have failed to meet their primary endpoints in both general SLE and LN, with only two biological drugs (belimumab and anifrolumab) being approved by the Food and Drug Administration (FDA) for the treatment of SLE. Recently, several Phase II randomized controlled trials have evaluated the efficacy and safety of new biologics in LN, and some of them have demonstrated an improvement in clinical and laboratory measures. Multi-target therapies are also being successfully developed and encourage a belief that there will be an improvement in LN outcomes.

Malignant hypercalcemia is a common finding in patients with advanced cancer, involving mechanisms like tumor secretion of parathyroid hormone (PTH)-related protein, osteolytic metastases, and tumor production of calcitriol. Although rare, hypercalcemia induced by ectopic tumoral secretion of PTH can be an additional mechanism. Here we present an 84-year-old male patient who was admitted to the hospital with a nonproductive cough, anorexia, and a single episode of small-volume hemoptysis. He was diagnosed with stage T4N3M1c left lung small cell carcinoma, and laboratory tests were remarkable for elevated ionized calcium as well as elevated serum intact PTH. A parathyroid 99mTc sestamibi scan showed no changes, suggesting ectopic production of PTH. Being a rare event, malignant hypercalcemia from intact PTH ectopic production should be considered in these patients.

Gastric metastasis is an infrequent occurrence, especially when derived from lung adenocarcinomas. They can grossly resemble advanced gastric cancer and require comprehensive evaluations of the patients and their symptoms.Here, we present the case of a 71-year-old patient admitted to our hospital due to intense, cramping abdominal pain. He had been previously diagnosed with a right lower lobe adenocarcinoma of the lung, which was treated in the previous year with chemotherapy and radiotherapy with good clinical response. The abdominal CT scan and the esophagogastroduodenoscopy showed a gastric infiltrating lesion resembling advanced gastric cancer. However, the biopsy showed malignant epithelial neoplasia with features of adenocarcinoma of pulmonary origin. Even though they are an uncommon finding, gastrointestinal metastases may be life-threatening and should be diagnosed as soon as possible, as the advent of molecular studies and new therapies may result in better survival rates.

Immune‐mediated diseases tend to overlap in ways that are not completely understood. When a presentation is not entirely explained by a former condition, other hypotheses should arise. Additionally, the activity of 2 overlapping immune‐mediated conditions is not always associated. We present an unusual association between Crohn's disease and dermatomyositis in a 28‐year‐old man. The patient presented with a 2‐month history of proximal muscle weakness and a skin rash with heliotrope periorbital edema. Since the patient had already been diagnosed with Crohn's disease, he was under immunosuppressive therapy, and he had a family history of psoriasis, the diagnosis was not immediate and required an integrative approach. Laboratory analysis revealed elevated creatine kinase, aldolase, lactic dehydrogenase and transaminase levels. He had no symptoms of Crohn's disease exacerbation. Magnetic resonance imaging, electromyography, and muscle biopsy findings were consistent with inflammatory myopathy, although non‐specific. Corticosteroids were initiated with clinical and laboratory improvement within 1 month.