A 24-year-old female with pneumonia two months prior presented with fever, cough, and worsening dyspnoea in the midst of a COVID-19 spike. Her initial episode was treated as COVID-19 pneumonia. On presentation, her chest computed tomography was suggestive of bilateral lower zone organising pneumonia with mild fibrosis and was attributed to post-COVID sequelae with an infective exacerbation. Oral steroids and antibiotics were administered, following which she had initial improvement and then subsequent deterioration requiring intensive care unit (ICU) care. A detailed clinical examination (in-person and virtually) at this point revealed the presence of pigmented rashes over the knuckles and weakness of hip muscles. Laboratory work showed elevated creatine kinase levels and positive anti-Ro and anti-Jo1 antibodies, which pointed to a diagnosis of antisynthetase syndrome. Unique attributes of this case include younger age of presentation in an atypical ethnic group, which are possibly incited by COVID-19 infection in the peak of a COVID-19 wave. The work-up, diagnosis, and initial management of this patient were carried out through a hybrid ICU model, which functioned as a traditional ICU in the day and a tele-ICU at night with an appropriate network of subspecialists including rheumatologists consulting, thus highlighting a collaborative model in a low-resource setting capable of managing rare cases even in the midst of increasing critical care needs during the pandemic.
Keywords: Antisynthetase syndrome; ICU; India; intensive care; rituximab.
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