Excerpt from the Editorial: In this issue of IMAJ, the occurrence of a plethora of psychoneuro-immunological symptoms (also called ASIA or Shoenfeld syndrome) is described in three different patients. Segal and co-authors present an 85 year old woman who underwent total hip replacement and experienced side effects. Patch testing showed hypersensitivity to cobalt and chromium. The metal components were replaced with ceramics and the symptoms disappeared. The second case, reported by Pineda and team, concerns a 53 year old woman with breast implants. Since silicone was found in her lymph nodes, removal of her implants was recommended. Finally, Cruz-Dominguez et al. present the thought-provoking case of a patient exposed subcutaneously to a large amount of metallic mercury. The case illustrates that mercury might act as a potent adjuvant, inducing ASIA.

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