We present a challenging clinical case of an antisynthetase syndrome (ASS) with a four-year follow-up. The disease debuted with skin manifestations and interstitial lung disease (ILD), then the severe Raynaud's phenomenon came to the fore with the development of occlusive vasculopathy and critical digital ischemia. After the relief of vascular lesions, the severity of the condition was determined by ILD. The use of combined pulse therapy with cyclophosphamide and methylprednisolone, treatment with intravenous immunoglobulin made it possible to reduce the activity of ASS: lung lesion and the progression of vasculopathy. However, after the termination of an unplanned pregnancy, the patient again experienced an exacerbation with ILD progression. It was decided to use rituximab, against which the patient's condition was stabilized. Clinical and laboratory remission was achieved, which was maintained for a year and a half. However, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic triggered a re-exacerbation of the pulmonary domain of the disease, which forced us to use a nintedanib with a positive clinical and instrumental effect.

Lyme disease (LD), also known as Lyme borreliosis, is a zoonotic disease caused by the Gram-negative bacteria Borrelia burgdorferi sensu lato belonging to the Spirochaetaceae family. Differentiating LD from other systemic disorders that present with musculoskeletal symptoms is challenging, and the presence of antibodies to borrelia in the general population may contribute to misdiagnosis. Moreover, long-term exposure of the host's immune system to spirochetes can contribute to the development of chronic autoimmune disease de novo. We report a 35-year-old woman with a combination of LD and systemic lupus erythematosus (SLE), and in this case, LD was the most likely trigger for SLE. We also performed a literature review and summarized the previously reported cases with a combination of LD and autoimmune disease.

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Retroperitoneal fibrosis (RPF) is a rare disease cha­racterized by the proliferation of inflammatory and fibrous tissue in the retroperitoneum. These masses are commonly loca­lized around the infrarenal part of the abdominal aorta and iliac arteries, often covering the ureters or other organs of the abdominal cavity; idiopathic diseases accounting for 70 % of cases. RPF may be associated with immunoglobulin G4 (IgG4), which accounts for two-thirds of idiopathic RPF cases. Secondary RPF may develop due to infections, malignant neoplasms, medication, retroperitoneal bleeding, or various other diseases. A cli­nical case of idiopathic RPF, probably associated with IgG4, was described in a patient who had undergone a symptomatic surgical treatment in an urological clinic and continued being trea­ted by a rheumatologist, given pathogenetic therapy (methylpredni­solone and mycophenolate mofetil) with a significant improvement. For rheumatologists, this pathology is of an undoubted clinical interest, since these changes are based on processes si­milar to those occurring in systemic diseases of the connective tissue, and the RPF is extremely rare, ranging from 0.1 to 1.3 cases per 100,000 patients per year. However, more often than not, such patients are referred to the doctors of ancillary specialties (urologists, nephrologists, surgeons, vascular surgeons). All of the abovementioned facts emphasize the importance of analyzing such a clinical case.

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