Autoimmune disorders are known to be more frequent in women and often associated each others, but it is rare to see multiple autoimmune diseases in a single patient. Recently, the concept of multiple autoimmune syndrome has been introduced to describe patients with at least three autoimmune diseases. We describe a case of a young man with a clinical history of psychiatric symptoms and celiac disease (CD) who was diagnosed to have other two autoimmune disorders: systemic lupus erythematosus (SLE) and Hashimoto’s thyroiditis. This case is unusual upon different patterns: the rare combination of the three autoimmune diseases, their appearance in a man and the atypical onset of the diseases with psychiatric symptoms likely to be related either to CD or to SLE.

Here we present the case of a 57-years old patient affected by hemophagocytic lymphohistiocytosis (HLH), a rare disease characterized by an uncontrolled immune activation, resulting in clinical and biochemical manifestations of extreme inflammation. In a previous hospitalization, the patient showed fever, hepato-splenomegaly, pancytopenia, hyperferrtitinemia, lymphadenopathy and cholestasis. No diagnosis was done, however, he totally recovered after splenectomy. Eight months later, he relapsed, showing also hypofibrinogenemia, hypertriglyceridemia, hemophagocytic signs in bone marrow, cholestatic jaundice, high LDH and high PT-INR. Interestingly, he presented increased levels of amylase and lipase in absence of radiologic signs of pancreatitis. He was treated with Dexamethasone and Cyclosporine according to HLH-2004 guidelines. The clinical and biochemical manifestations disappeared in a few weeks, but he was newly hospitalized for lower limbs hypotonia caused by a hemophagocytic lesion of the cauda equina and lumbar cord. The death occurred in a few days, despite the immunosuppressive treatment.

The pseudotumoral form of tuberculosis is very rare in healthy immunocompetent subjects and can simulates lung carcinoma causing diagnosis dilemma or lead to abusive surgical resection. Here we report a case of pulmonary tuberculosis in its pseudotumoral form in an immunocompetent old men who presented with cough, fatigue and fever. A computerized tomography of the chest indicated a dishomogeneous mass that compressed and deformed the left main bronchus that was referable to a primary tumor. The hystopatological exam from the bioptic samples obtained by bronchoscopy was negative for neoplasia. Moreover, an abdomen CT scan showed hypodense solid lesions of the liver likely to be considered as metastasis; the histological analysis of these hepatic lesions was negative for neoplasia. It was necessary to perform a second CT scan of the chest and another bronchoscopy with biopsy and histopathological examination before establishing the diagnosis of the pulmonary pseudotumoral form. The case report confirm, as previously described, the difficulties in the diagnosis of this rare form of tuberculosis that lead to a delay in therapy, and suggest that the pseudotumor has to be included as different diagnosis of pulmonary mass also in healthy immunocompetent subjects.