Even if it looks like COVID-19, think again: the importance of differential diagnosis during a pandemic

Acta Clin Belg. 2022 Apr;77(2):416-420. doi: 10.1080/17843286.2021.1872312. Epub 2021 Jan 15.

Abstract

Introduction: Antisynthetase syndrome (ASSD) is a rare auto-immune condition that can present as interstitial lung disease (ILD) and progress into Acute Respiratory Distress Syndrome (ARDS).

Importance: The purpose of this clinical case is to highlight the importance of considering less prevalent causes of ARDS amid the COVID-19 pandemic.

Case report: We present a 56-year-old Belgian female of African descent without past medical history who demonstrated typical signs of COVID-19 at the start of the pandemic. Based on the disease course as well as CT-scan findings, a diagnosis of COVID-19 was made. She progressed to ARDS for which she got intubated and was started on venovenous membrane oxygenation (VV-ECMO). Despite initial negative screening for antinuclear antibodies, further analysis revealed anti-Jo-antibodies. Diagnosis of ASSD was eventually retained and immunosuppressive therapy was started. However, pulmonary fibrosis had evolved too far and therapy was halted shortly after.

Keywords: Acute respiratory distress syndrome (ARDS); antisynthetase syndrome (ASSD); coronavirus disease 2019 (COVID-19).

Publication types

  • Case Reports

MeSH terms

  • COVID-19*
  • Diagnosis, Differential
  • Extracorporeal Membrane Oxygenation*
  • Female
  • Humans
  • Middle Aged
  • Pandemics
  • SARS-CoV-2