A Case of Anti-Synthetase Syndrome With Anti-Glycyl tRNA Synthetases Antibody Developed After COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is a life-threatening respiratory disease characterized by severe acute infection. In some cases, COVID-19 symptoms may persist for a long term, posing a significant social problem. Long-term COVID-19 symptoms resemble those observed in various autoimmune diseases, such as dermatomyositis and polymyositis. In this report, we present the case of a 55-year-old woman who had been experiencing persistent dyspnea on exertion since contracting COVID-19 a month ago and was subsequently diagnosed with anti-synthetase syndrome (ASS). The patient presented with fever, dyspnea, rash, mechanic's hands, and arthritis. Computed tomography imaging revealed findings indicative of interstitial pneumonia. Immunological test results were positive for anti-EJ antibody, leading to a diagnosis of ASS based on Solomon's established criteria. The patient's condition improved following treatment with prednisolone, tacrolimus, and intravenous cyclophosphamide. Pathological findings of transbronchial biopsy revealed nonspecific interstitial pneumonia with organizing pneumonia, leading to speculation that ASS had developed after COVID-19. Given the scarcity of reports on ASS development post COVID-19, we conducted a literature review and compared our present case to previous ones. This report highlights the importance of considering ASS in the differential diagnosis of patients with long-term COVID-19 symptoms.

Keywords: aminoacyl-trna synthetases; anti-ej antibody; anti-synthetase syndrome; covid-19; long covid; long-term covid-19.

Figure 1. Chest radiography of the patient before and after treatment

(A) Chest radiography at the first visit: attenuation of the inferior lung observed; (B) Chest radiograph on the day of discharge: improved attenuation of the inferior lung.

Figure 2. Chest CT of the patient before and after treatment.

(A and B) Chest CT at the first visit: peribronchial infiltrative shadows are predominant in the bilateral lung bases; (C and D) Chest CT on day 19 of hospitalization: peribronchial infiltrative shadows are improved.

Figure 3. Pathological transbronchial lung biopsy findings.

Pathological examination revealed mild lymphocytic infiltration, diffuse collagen fibrosis in the alveolar septum, and granulation tissue formation in the airspace, indicated by the arrow, consistent with nonspecific interstitial pneumonia with organizing pneumonia. (A) Hematoxylin and eosin staining, 100× magnification; (B) Elastica van Gieson staining, 100× magnification; (C) Elastica van Gieson staining, 40× magnification.

Figure 4. Clinical course of the patient.

IVCY, intravenous cyclophosphamide; PSL, prednisolone; Tac, tacrolimus; %VC, % vital capacity; FEV1%, forced expiratory volume in one second %, %DLco, diffusing capacity of the lung for carbon monoxide; COVID-19, coronavirus disease 2019