Beyond Myositis: The Systemic Complications of Antisynthetase Syndrome

Abstract

Aims: This case report aims to highlight the systemic complications and clinical challenges associated with Antisynthetase Syndrome (ASyS), a rare autoimmune condition characterized by antibodies targeting aminoacyl-tRNA synthetases. Presentation of Case: A 65-year-old woman with a history of diabetes and hypertension presented with progressive muscle weakness, bilateral leg swelling, and respiratory symptoms. Diagnostic evaluations—including MRI, HRCT, muscle biopsy, and laboratory tests—confirmed necrotizing myositis and interstitial lung disease (ILD), consistent with ASyS. Despite treatment with high-dose corticosteroids and intravenous immunoglobulin (IVIG), the patient experienced persistent quadriparesis, respiratory compromise, and gastrointestinal bleeding due to gastric ulcers. Discussion: This case illustrates the complex clinical spectrum of ASyS, with concurrent myositis, ILD, systemic inflammation, cardiac involvement, and gastrointestinal complications. Elevated muscle enzymes, severe anemia, leukocytosis, and the presence of mechanic’s hands supported the diagnosis. Management involved immunosuppressive therapy, broad-spectrum antibiotics, antifungal prophylaxis, and supportive measures. The patient’s partial response to treatment underscores the chronic, relapsing nature of ASyS. A multidisciplinary approach was essential for comprehensive care. Conclusion: ASyS poses significant diagnostic and therapeutic challenges due to its multisystem involvement and variable presentation. Early recognition, aggressive immunosuppressive therapy, infection control, and organ-specific management are critical. Long-term multidisciplinary follow-up is necessary to monitor disease progression, mitigate complications, and improve patient outcomes.