SHM Converge Scientific Abstract ePoster Gallery-Pl12 Positive Antisynthetase Syndrome Manifesting With Fever of Unknown Origin

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This case report describes anti-PL12 positive antisynthetase syndrome (ASyS) presenting as fever of unknown origin in a 41-year-old Asian woman with known interstitial lung disease (ILD), Raynaud’s phenomenon, and Sjögren’s syndrome. She was hospitalized with more than three weeks of worsening dyspnea, malaise, fevers, chills, and body aches. Despite outpatient antibiotics and steroids, her symptoms progressed. On admission, she had low-grade fever, tachycardia, tachypnea, hypotension, bilateral lower-lobe crackles, and hyperkeratotic rash on her palms. Labs showed marked leukocytosis and anemia. CT imaging revealed worsening pulmonary fibrosis, enlarged pulmonary artery, mediastinal lymphadenopathy, and splenomegaly.<br /><br />She was treated empirically with broad-spectrum antibiotics, but infectious evaluation including cultures, imaging, viral testing, and bronchoalveolar lavage was negative. Rheumatologic testing showed elevated CRP and positivity for anti-PL12 and anti-SSA-52 antibodies, while CK and LDH were normal. Based on these findings, she was diagnosed with antisynthetase syndrome. Her fevers resolved after starting steroids.<br /><br />After discharge, she remained under rheumatology care on mycophenolate and prednisone. Pulmonary function testing showed severe restrictive disease with very low FVC, and she required oxygen with exertion. Her condition remained stable, though lung transplantation may be needed in the future.<br /><br />The report highlights that ASyS can present with prolonged fever and mimic fever of unknown origin, that ILD may be the dominant and prognostically important feature, and that early rheumatologic evaluation is important in patients with unexplained ILD. It also emphasizes that ASyS may be associated with anti-PL12 and Sjögren’s-related antibodies.

Asset Subtitle

Palina Sudnik

Meta Tag

Author List Anika A. Malik, Palina Sudnik

Category Clinical Vignettes

Concept Antisynthetase Syndrome

Concept Interstitial Lung Disease

Concept Autoantibody

Concept Corticosteroids

Concept Anti-PL12 Antibody

Distinguished Non-Finalist

Presenter Organization St. Luke's University Health Network

Presenting Author Palina Sudnik

Track Adult

Keywords

antisynthetase syndrome

anti-PL12

fever of unknown origin

interstitial lung disease

Sjögren’s syndrome

Raynaud’s phenomenon

mycophenolate

prednisone

pulmonary fibrosis

rheumatologic evaluation

Antisynthetase Syndrome

Interstitial Lung Disease

Autoantibody

Corticosteroids

Anti-PL12 Antibody