The antisynthetase syndrome as a diagnostic challenge: A case report

ABSTRACT

Background: Idiopathic inflammatory myopathies are a heterogeneous group of pathological conditions characterized by muscle inflammation, and sometimes by inflammatory involvement of other organs, such as skin (in dermatomyositis) and lungs (pulmonary interstitial disease). Description of the case 54-year-old woman, turns to the Emergency Room of Miulli Hospital in March 2021 for worsening dyspnea. In medical history previous recent SARS-CoV-2 infection. She is admitted to Medicine Unit, where the characteristic signs and symptoms of myositis were objected myasthenia affecting the proximal muscles, myalgias, plantar desquamation of the feet (climber's foot) and fingers (mechanic's hands), Gottron's papules. There are also pericardial effusion, signs of pulmonary hypertension on echocardiogram, consolidating pulmonary parenchymal changes with fibrotic evolution on HR chest CT. She is transferred to the Rheumatology Unit of the Policlinico Di Bari to perform specific autoantibody panel (positivity of ANA, anti Jo- 1, anti Ro52), electromyography (signs of myogenic suffering), MRI of the thighs (hypotrophy and adipose replacement of the muscles of the posterior lodge) and muscle biopsy, indicative of muscle inflammation. Therapy with steroid boluses and cyclosporine 5mg/kg/day, shows quick effectiveness, and she is discharged with the diagnosis of antisynthetase syndrome. Conclusions: The diagnosis of antisynthetase syndrome is not always easy, due to the clinical heterogeneity of the disease and the need for specific instrumental and laboratory tests.