SHM Converge Scientific Abstract ePoster Gallery-When Antibiotics Aren't Always the Answer: A Case of Pl12 Positive Anti-Synthetase Syndrome

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This case describes a 75-year-old woman with diabetes, asthma, and arthritis who presented with three months of recurrent “pneumonia,” progressive weakness, shoulder pain, shortness of breath, cough, new wrist swelling, and fever. Despite multiple prior antibiotic courses, her respiratory symptoms persisted. On admission, she had leukocytosis, anemia, elevated inflammatory markers, bilateral crackles, edema, and worsening basilar lung consolidation on imaging. Because she appeared relatively stable and had already failed several antibiotics, empiric antibiotics were withheld.<br /><br />During hospitalization, she developed a diffuse pruritic rash. Skin biopsy showed urticarial vasculitis, and lung biopsy demonstrated organizing pneumonia. Extensive infectious and rheumatologic evaluation was negative except for a myositis panel positive for PL-12 antibody, confirming anti-synthetase syndrome (ASS). She was treated with high-dose intravenous methylprednisolone for three days, then discharged on prednisone with close follow-up by pulmonology, rheumatology, and dermatology.<br /><br />The report highlights that ASS is a rare autoimmune disease associated with antibodies such as anti-Jo1, anti-PL7, and anti-PL12, and can present with fever, myositis, arthritis, Raynaud’s phenomenon, mechanic’s hands, and especially interstitial lung disease. PL7/PL12-positive disease is linked to more severe progressive lung involvement. Urticarial vasculitis is not a typical skin manifestation of ASS, suggesting an additional autoimmune process in this patient.<br /><br />The main lesson is that recurrent “pneumonia” unresponsive to antibiotics should prompt consideration of autoimmune causes like ASS, particularly when lung disease and systemic symptoms are present.

Asset Subtitle

Meghan E. Reilly

Meta Tag

Author List Anthony Bilotta, Meghan E. Reilly, Robert Le

Category Clinical Vignettes

Concept Antisynthetase Syndrome

Concept Interstitial Lung Disease

Concept Myositis

Concept Corticosteroids

Concept Arthritis

Distinguished Non-Finalist

Presenter Organization UMass Chan Medical School

Presenting Author Meghan E. Reilly

Track Adult

Keywords

anti-synthetase syndrome

PL-12 antibody

organizing pneumonia

urticarial vasculitis

interstitial lung disease

recurrent pneumonia

autoimmune disease

myositis panel

high-dose corticosteroids

rheumatologic evaluation

Antisynthetase Syndrome

Interstitial Lung Disease

Myositis

Corticosteroids

Arthritis