The clinical manifestations at the onset of antisynthetase syndrome: A chameleon with multiple faces.

The antisynthetase syndrome (ASS) is clinically characterized by fever, myositis, interstitial lung disease, joint involvement, mechanic's hands, or Raynaud's phenomenon, and the presence of antisynthetase autoantibodies. These clinical manifestations may not occur simultaneously. Therefore, the aim of this study was to analyze the sequence in which these clinical manifestations can develop at the onset of ASS. This retrospective, single-center cohort study enrolled 55 ASS patients. Their mean age at the onset of ASS symptoms was 42.3±11.8 years. There was a predominance of female patients (75.9%) and white patients (72.7%). At initial presentation, 41.8% of the patients had fever, 43.6% had joint symptoms, 38.2% had myositis, 36.4% had interstitial lung disease, 18.2% had Raynaud's phenomenon, and 16.4% had mechanic's hands. Subsequent clinical symptoms emerged at varying time points. In two out of 55 cases, joint, muscle, and lung manifestations developed simultaneously. The median time between the onset of symptoms and the complete ASS clinical manifestation was 19.9 (4.0-60.2) months; whereas, the timeframe between the onset of symptoms and the ASS diagnosis was 29.0 (11.0-63.0) months. The confounding misdiagnoses interfering with the initial diagnosis were polymyositis (52.7%), dermatomyositis (29.1%), nonspecific interstitial pneumopathy (23.6%), rheumatoid arthritis (18.2%), and others (10.9%). Clinical features at the onset of ASS are highly variable. Consequently, confounding factors can lead to significant delays for the final and definitive diagnosis of ASS. Therefore, ASS should be considered a differential diagnosis in patients with initial symptoms of joint, lung, and/or muscle involvements, as well as fever, mechanic's hands, and/or Raynaud's phenomenon manifestations.

[Gallstone ileus]. / L'ileo biliare.

Gallstone ileus is a rare condition whose diagnosis may be difficult. From January 1976 to December 1991 4 cases of gallstone ileus were treated in our hospital, representing 1% of all patients admitted with mechanical bowel obstruction during that period. Three patients were treated by enterolithotomy alone to remove the impacted stone. In one patient intestinal resection of the bowel tract was associated followed by end to end anastomosis. One patient died (33%) seven days after surgery for cardiopulmonary failure. In one patient the obstruction resolved with the passage of a stone per rectum. The Authors conclude that enterolithotomy alone should be the standard procedure for gallstone ileus. The repair of cholecyst-enteric fistula should be done later only if there are continuing or recurrent symptoms.