BACKGROUNDSystemic lupus erythematosus (SLE) is a chronic autoimmune disorder, characterized by alternating disease activity and remission, often affecting young women, in a 9:1 ratio. Cutaneous lupus affects the skin and mucosa, and lesions in the oral cavity are varied, such as canker sores and ulcers. SLE is associated with a higher risk of developing neoplastic transformation, whose mechanism is still poorly recognized; however, it is suggested that disease activity and prolonged use of immunosuppressive therapy are important triggers. There are few cases of squamous cell carcinoma (SCC) reported in the literature, especially in the oral cavity. The report describes a case of SCC in the tongue diagnosed in a patient with SLE. CASE REPORTA 26-year-old female patient undergoing regular follow-up at a tertiary hospital rheumatology outpatient clinic, diagnosed with SLE in 2011, associated with antiphospholipid syndrome (APS). She was diagnosed with human papillomavirus (HPV) infection in 2020 after colposcopy, which showed lowgrade squamous intraepithelial neoplasm. At the time, she received treatment with laser therapy and maintained remission, with routine consultations with gynecology. In 2021, she developed an ulcerated lesion on the right lateral surface of the tongue, whose pathology study showed a well-differentiated, invasive, keratinizing SCC. She underwent right hemiglossectomy, with lymphatic dissection of the homolateral cervical chain, protective tracheostomy and tongue graft, followed by 30 sessions of radiotherapy. The graft was lost, however, therapeutic success was achieved, evidenced by free margins in the anatopathological sample and the absence of distant metastasis. CONCLUSIONSLE is a potentially malignant condition and there are few reports in the literature of association with oral SCC. Oral ulcerated lesions are common in SLE; however, it is important to consider malignant transformations, as in the case above. The attending physician must be aware of this possibility, taking into account clinical suspicion and early identification of cases, in order to obtain better outcomes.

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BACKGROUNDPatients with autoimmune diseases, for the most part, need continuous or prolonged use of immunosuppressive drugs. In the midst of the therapeutic arsenal, the use of the subcutaneous (SC) route has been an important treatment option for such patients. The objective of this study was to evaluate the perception of patients regarding the use of immunosuppressive drugs administered via the SC route. METHODSAn observational, cross-sectional study was carried out with the application of a questionnaire to patients over 18 years of age, followed up at the rheumatology center in a tertiary hospital, users of at least two doses of immunosuppressive medication administered subcutaneously. RESULTSA total of 123 patients were interviewed, most of them with rheumatoid arthritis (76%) and spondyloarthropathy (19%), of female gender (84%), with a mean age of 66 years. Medication at home was taken for 76% of the patients, and in 68% of the cases the application was done by the patient, with 27% reporting some difficulty at the time of application and 30% preferring to modify it to perform it in a supervised way. However, only 14% of them reported some degree of insecurity in performing it at home; 24% of the patients apply the medication in some health establishment, being 50% in the basic health units and 50% in the infusion center of the hospital; 85% of respondents stored the medication correctly, but 12% reported recurrent lack of light in their home. Of the patients who took their medication at home, 18% reported delays in taking the medication versus 13% of the group who attended a health facility. CONCLUSIONThe use of SC immunosuppressive drugs has been used for a long time in autoimmune diseases and an adequate explanation about the care with the medication, as well as its application, in addition to the patients' understanding of their own condition, are factors that favor adherence to the medication. treatment and, therefore, better outcomes.

BACKGROUNDImmune-mediated necrotizing myopathy (IMNM) is a subgroup of systemic autoimmune myopathies characterized histologically by the presence of necrotic muscle fibers and the absence or minimal presence of inflammatory cell infiltrate. Clinically, it is characterized by significant proximal muscle weakness. Laboratory examination shows a significant elevation of serum muscle enzymes, in addition to the presence of anti-signal recognition particle (SRP) or anti-3-hydroxy-3-methyl-glutaryl-coenzyme A reductactase (HMGCR) autoantibodies. IMNM affects mainly adults, women, with a peak between 40 and 50 years. IMNM results from the interaction of environmental factors in genetically predisposed individuals. In the form associated with the anti-HMGCR autoantibody, the HMGCR enzyme is exposed to the cell membrane, functioning as an antigen. HMGCR exposure is most often triggered by exposure to statins. We will report a case of IMNM in an elderly patient, with previous exposure to statin. CASE REPORTFemale, 70 years old, white, with a history of systemic arterial hypertension, dyslipidemia, type 2 diabetes, hypothyroidism and osteoporosis. In use of venlafaxine, AAS, zolpidem and dexlansoprazole. She was hospitalized with a history of generalized weakness, diffuse myalgia, profuse sweating, dysphagia, and weight loss of 10 kg, beginning 4 months prior to admission. On clinical examination, the patient presented grade II muscle strength assessment-Manual Muscle Testing (MMT-8). Laboratory evaluation showed a significant increase in muscle enzyme (creatine phosphokinase: 9,000 U/L). The search for autoantibodies was negative, except for the positivity of anti-HMGCR. Investigation for neoplasia was also negative. Muscle biopsy showed moderate to severe myopathy, with the impression of chronic polymyositis probably associated with a statin. The patient reported previous use of simvastatin for 3 years, being suspended at the beginning of the condition, when muscle weakness started. She received pulse therapy with 1 g of methylprednisolone, 3 days in a row, and opted for the use of oral methotrexate and intravenous human immunoglobulin, applied monthly, for 5 months, in addition to a gradual reduction in corticosteroids. She evolved with clinical and laboratory improvement. CONCLUSIONStatin-induced necrotizing myopathy is a rare condition with a challenging, sometimes time-consuming diagnosis, depending on the availability of specific tests. However, when recognized in time, there is effective treatment with good clinical response. It is important to consider the diagnosis in the face of myopathy with marked elevation of muscle enzymes, regardless of age, in patients exposed to statins.

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