A rare presentation of antisynthetase syndrome requiring intensive care in the midst of a COVID wave

Mod Rheumatol Case Rep. 2023 Jun 19;7(2):394-398. doi: 10.1093/mrcr/rxac088.


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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • COVID-19* / complications
  • COVID-19* / diagnosis
  • Critical Care
  • Female
  • Humans
  • Myositis* / complications
  • Myositis* / diagnosis
  • Young Adult


  • Anti-Bacterial Agents

Supplementary concepts

  • Antisynthetase syndrome