Acute hypoxic respiratory failure secondary to antisynthetase syndrome: A case report and review of literature

OBJECTIVE: Antisynthetase syndrome is a condition that includes interstitial lung disease and inflammatory myositis in its definition. The interstitial lung disease of this syndrome can vary in severity and if not identified soon enough, can lead to severe respiratory failure. Here we present a patient who had a working diagnosis of acute eosinophilic pneumonia. He initially improved after prolonged hospitalization and course of high dose steroids. CT chest revealed interval improvement in his bilateral ground glass and reticular opacities but residual fibrotic interstitial lung disease. However, he decompensated subsequently with relapsed hypoxia during activity. We hope that this review will bring awareness to antisynthetase syndrome and provide tools for earlier diagnosis and treatment. The primary objective of this study was to review presenting symptoms, diagnosis, treatment and outcomes. This review is unique because we focused on antisynthetase syndrome that initially manifested with lung symptoms rather than myositis or skin changes. METHODS: We have performed a comprehensive review of 30 cases of antisynthetase syndrome in the literature (including our case). RESULTS: Total 30 cases reported, 17 male patients and 13 female patients. Only 43% of the cases presented with lung symptoms alone, while 57% of the cases presented with lung and muscle symptoms simultaneously. CONCLUSION: This supports the fact that antisynthetase syndrome most commonly presents with lung and muscle manifestations simultaneously. The fact that our case presented with lung findings alone led to the delay in his diagnosis.