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Adult Still's disease is a rare systemic disorder of unknown etiology. Its course is often complicated by interstitial pneumonia and fulminant hepatitis. Published data have indicated some common mechanisms of systemic inflammation in patients with autoimmune disorders and SARS-COV-19. We present a clinical case of a 74-year old female patient with a long standing, slowly progressive Stills disease, who developed honeycomb lung and severe liver injury as major syndromes after a novel coronavirus infection. Within 10 months, she developed increasing dyspnea, progressive fibrous pulmonary abnormalities with formation of a "honeycomb lung" and signs of liver failure. Due to late medical referral, these symptoms have led to the patients death. According to the literature, lung tissue abnormalities that persist after a new coronavirus infection in patients with autoimmune disorders can be both a manifestation of residual post-covid injury and a systemic disease-associated lung injury with COVID-19-triggered progression. By this clinical example, we intended to illustrate that the key to a correct diagnosis is multiple organ damage persisting after a novel coronavirus infection irrespective of the severity of the coronavirus lung injury. Such symptoms indicate the need to assess immunological markers to exclude an autoimmune disease exacerbation or onset. Clinicians should aim at rapid diagnosis and timely initiation of specific therapy.

Aim. Assess the detection of rare computed tomographic features and their combination to detect cases of fibrotic hypersensitivity pneumonitis (HP). A retrospective analysis of data from high-resolution computed tomography of the lungs was performed in 52 patients with fibrotic hypersensitivity pneumonitis (fHP), in whom the clinical diagnosis was confirmed by morphological examination of lung biopsy. The analysis of the identified changes was carried out by qualitative and quantitative methods. The study included signs common to non-fibrotic and fibrotic hypersensitivity pneumonitis of HP, including ground glass symptom, mosaic density, centrilobular lesions, and emphysema. Separately, features related to pulmonary fibrosis in fHP, such as reticular changes, traction bronchiectasis, and honeycombing, were analyzed. In addition, the distribution parameters of these signs were determined separately in the cranio-caudal direction and in the axial plane. To search for combinations of tomographic features that are significant in the diagnosis, a correlation analysis of the identified changes was carried out. Materials and methods. The revealed CT-signs of fHP in most cases correspond to the clinical recommendations for the diagnosis of HP. However, in fHP, signs were found with a high frequency that did not correspond to the typical picture of HP, in particular, the "ground glass" symptom. On the contrary, a relatively low percentage of occurrence was observed in relation to centrilobular lesions and "mosaic density", which were also an important part of the typical HP pattern. Emphysema, which is not included in any of the HP patterns, was noted with a relatively high frequency, and in some cases was combined with the "honeycomb lung" symptom. The greatest strength of the correlation was found in such combinations of signs as "frosted glass" + reticular changes; "frosted glass" + "mosaic density"; reticular changes + "mosaic density"; emphysema + centrilobular foci, as well as reticular changes + bronchiectasis. These combinations occurred with a relatively high frequency among the examined patients. Results. Most of the identified changes correspond to current recommendations for the diagnosis of HP. A weak correlation between the signs does not allow us to identify combinations of signs with sufficient reliability that can help in the early diagnosis of HP.

Non-typhoid Salmonella gastroenteritis is one of the most common forms of intestinal infections among the population of developed countries and generalized forms of infection are rare. We present a case of 67-year-old woman with salmonaella sepsis, deep venous thrombosis, and septic thromboembolism of pulmonary artery complicated with development of necrotizing pneumonia. Generalization of the infectious process was mediated by the presence of polymorphisms in the TLR4 gene. Development of pulmonary infarction is infrequent. Even rarer is a formation of cavities in infarcted lung tissue, usually in the background of the infectious disease. A combination of 2 rare conditions in 1 patient demonstrates the need of multidisciplinary approach in treatment of severe and atypical forms of infectious diseases to evaluate the primary etiology of such state. The article will discuss various aspects of lung tissue damage caused by Salmonella and give a brief overview of the literature on this topic.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) resulting from an immune-mediated response in susceptible and sensitized individuals to a large variety of inhaled antigens. Chronic HP with a fibrotic phenotype is characterized by disease progression and a dismal prognosis. The aim of this study was to identify predictors of progression and mortality in patients with chronic HP in real clinical practice. Materials and methods: This retrospective, multicenter, observational study used data from a registry of 1355 patients with fibrosing ILDs. The study included 292 patients diagnosed with chronic HP based on the conclusion of a multidisciplinary discussion (MDD). Results: The patients were divided into groups with progressive (92 (30.3%) patients) and nonprogressive pulmonary fibrosis (200 (69.7%) patients). The most significant predictors of adverse outcomes were a DLco < 50% predicted, an SpO2 at the end of a six-minute walk test (6-MWT) < 85%, and a GAP score ≥ 4 points. Conclusion: Pulmonary fibrosis and a progressive fibrotic phenotype are common in patients with chronic HP. Early detection of the predictors of an adverse prognosis of chronic HP is necessary for the timely initiation of antifibrotic therapy.