Try your hand at this medical mystery, which is followed by some didactics on a fascinating disease which will hopefully make sense of this inscrutable title. Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Intro :22 What to expect in each episode :30 The case: A 75-year-old man with Sjogren’s and MALT lymphoma presents with recurrent cerebral infarcts of multiple territories 1:10 Rheumatology is consulted 6:11 Decreased sensation in toes occurs between strokes 7:14 What’s going on with this patient? 8:36 What additional labs can we perform? 9:36 We spin the urine 11:10 What kind of vasculitis are Sjogren’s and lymphoma associated with? 12:22 C3 and C4 had already been performed 13:00 An overall picture of this patient 13:54 What about the strokes? 14:19 Should we do more imaging? 15:57 At this point we can make a clinical decision 16:33 Why make a decision so quickly vs. waiting for biopsy? 18:18 Two things you must check before moving forward with a cryoglobulinemic vasculitis 19:46 Spoiler alert: The patient is doing really well 20:16 Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. What is cryoglobulinemic vasculitis? 21:00 What are these immunoglobulins? There are three types of cryoglobulins 22:55 Usually driven by another identifiable disease 25:18 What is making these immunoglobulins? 26:49 We don’t know why these immunoglobulins behave this way 27:18 How do you explain the kidneys? 28:28 What’s occurring at the tissue level? 29:35 How does type 1 present? 30:50 Type 2 and type 3 31:12 What other organ systems are involved? 33:11 I hope you enjoyed this patient presentation 36:00 What we’ll discuss in episodes 2 and 3 36:05 Thanks for listening 38:03 **Coming soon from Healio, Unmasking COVID-19, a podcast hosted by Gitanjali Pai, MD, infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma. In this timely new show, Dr. Pai will explore COVID-19’s impact on vulnerable patient populations by answering questions from experts in various medical fields, including oncology, endocrinology and rheumatology. To submit your question for Dr. Pai, email covid19podcast@healio.com.** We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO @CCalabreseDO Disclosure: Brown reports no relevant financial disclosures. References: Fuentes A, et al. Current Rheumatology Reports. 2019;21:60. Silva F, et al. J Autoimmun. 2019;105:102313.