BACKGROUND Antisynthetase syndrome(ASS)is characterized by the presence of antisynthetase antibodies coupled with clinical findings such as fever,polymyositis-dermatomyositis and interstitial lung disease.It is,howeve...BACKGROUND Antisynthetase syndrome(ASS)is characterized by the presence of antisynthetase antibodies coupled with clinical findings such as fever,polymyositis-dermatomyositis and interstitial lung disease.It is,however,rare to observe ASS association with B cell lymphoma presenting severe pneumonia as the first clinical manifestation.CASE SUMMARY We evaluated a 59-year-old male patient who presented with cough with sputum,shortness of breath and fever for 13 d.A chest computed tomography radiograph revealed bilateral diffuse ground-glass infiltrates in both upper fields,left lingual lobe and right middle lobe.Initially,the patient was diagnosed with severe community-acquired pneumonia and respiratory failure.He was empirically treated with broad-spectrum antibiotics,without improvement.Further analysis showed an ASS panel with anti-PL7 antibodies.Besides,electromyography evaluation demonstrated a manifestation of myogenic damage,while deltoid muscle biopsy showed irregular muscle fiber bundles especially abnormal lymphocyte infiltration.In addition,bone marrow biopsy revealed high invasive B cell lymphoma.Thus,the patient was diagnosed with a relatively rare anti–PL7 antibody positive ASS associated with B cell lymphoma.CONCLUSION This case highlights that rapidly progressive lung lesions and acute hypoxemic respiratory failure associated with heliotrope rash and extremely high lactate dehydrogenase level should be considered as the characteristics of non-infectious diseases,especially ASS and B cell lymphoma.展开更多
To the Editor:A 25-year-old male patient was admitted to the First Affiliated Hospital,School of Medicine,Zhejiang University with complaints of fever,cough,and knee pain.He was an overseas student and had been back f...To the Editor:A 25-year-old male patient was admitted to the First Affiliated Hospital,School of Medicine,Zhejiang University with complaints of fever,cough,and knee pain.He was an overseas student and had been back from the USA for 3 weeks,with no remarkable medical history before admission.He was initially diagnosed with a cold and given non-steroidal anti-inflammatory analgesics and oral antibiotics in a clinic.However,his symptoms were not alleviated.Swelling and pain in his left knee became worse so that normal walking was not possible.Gradually a red rash with mild pain above the epidermis appeared in the lower limbs.Then,the patient presented to a municipal hospital in Hangzhou,China,and underwent a chest computed tomography(CT)scan,which revealed highdensity areas in both the left lower lobe[Figure 1A]and left hilum[Figure 1B].Laboratory tests indicated the following results:white blood cell(WBC)count 11.6×10^9/L,neutrophils 88.2%,and C-reaction protein(CRP)70.3 mg/dL.Community-acquired pneumonia was considered first,and empirical anti-bacterial treatment(moxifloxacin injection,400 mg per day)was administered.The patient did not improve despite the use of moxifloxacin injections for 1 week but did have an elevation in liver enzymes(alanine transaminase[ALT]191 U/L and aspartic transaminase[AST]121 U/L),higher WBC count(16.6×10^9/L)and higher CRP(213 mg/dL).His left knee joint swelling progressed,and the pain worsened.A magnetic resonance imaging scan of his left knee revealed edema of the bone marrow in the distal femur as well as joint effusion[Figure 1C].Meanwhile,the skin lesions increased in number and became larger,and some of the lesions ruptured and discharged pus[Figure 1D].Bronchoscopy results revealed a neoplasm in the left lingular bronchus(B4+B5),and tissue biopsy reported suspicious spore-like substances.Because of the difficulty of diagnosis,the patient was transferred to the Respiratory Department,First Affiliated Hospital,School of Medicine,Zhejiang University on May 28th,2018.On admission,we thoroughly reviewed his medical history and learned that he had lived in Vermont,which is located in the northeastern United States.For 4 years,the patient had not traveled outside Vermont.Physical examination findings included a low fever of 37.8℃,positive floating patella test in the left knee joint,and clusters of skin lesions,presenting as swellings,pustules,ruptures,and incrustations on the lower limbs.No abnormal breathing sounds or rales were heard.展开更多
基金Supported by National Natural Science Foundation of China,No.81900020Natural Science Foundation of Zhejiang Province,China,No.LQ19H160020.
文摘BACKGROUND Antisynthetase syndrome(ASS)is characterized by the presence of antisynthetase antibodies coupled with clinical findings such as fever,polymyositis-dermatomyositis and interstitial lung disease.It is,however,rare to observe ASS association with B cell lymphoma presenting severe pneumonia as the first clinical manifestation.CASE SUMMARY We evaluated a 59-year-old male patient who presented with cough with sputum,shortness of breath and fever for 13 d.A chest computed tomography radiograph revealed bilateral diffuse ground-glass infiltrates in both upper fields,left lingual lobe and right middle lobe.Initially,the patient was diagnosed with severe community-acquired pneumonia and respiratory failure.He was empirically treated with broad-spectrum antibiotics,without improvement.Further analysis showed an ASS panel with anti-PL7 antibodies.Besides,electromyography evaluation demonstrated a manifestation of myogenic damage,while deltoid muscle biopsy showed irregular muscle fiber bundles especially abnormal lymphocyte infiltration.In addition,bone marrow biopsy revealed high invasive B cell lymphoma.Thus,the patient was diagnosed with a relatively rare anti–PL7 antibody positive ASS associated with B cell lymphoma.CONCLUSION This case highlights that rapidly progressive lung lesions and acute hypoxemic respiratory failure associated with heliotrope rash and extremely high lactate dehydrogenase level should be considered as the characteristics of non-infectious diseases,especially ASS and B cell lymphoma.
文摘To the Editor:A 25-year-old male patient was admitted to the First Affiliated Hospital,School of Medicine,Zhejiang University with complaints of fever,cough,and knee pain.He was an overseas student and had been back from the USA for 3 weeks,with no remarkable medical history before admission.He was initially diagnosed with a cold and given non-steroidal anti-inflammatory analgesics and oral antibiotics in a clinic.However,his symptoms were not alleviated.Swelling and pain in his left knee became worse so that normal walking was not possible.Gradually a red rash with mild pain above the epidermis appeared in the lower limbs.Then,the patient presented to a municipal hospital in Hangzhou,China,and underwent a chest computed tomography(CT)scan,which revealed highdensity areas in both the left lower lobe[Figure 1A]and left hilum[Figure 1B].Laboratory tests indicated the following results:white blood cell(WBC)count 11.6×10^9/L,neutrophils 88.2%,and C-reaction protein(CRP)70.3 mg/dL.Community-acquired pneumonia was considered first,and empirical anti-bacterial treatment(moxifloxacin injection,400 mg per day)was administered.The patient did not improve despite the use of moxifloxacin injections for 1 week but did have an elevation in liver enzymes(alanine transaminase[ALT]191 U/L and aspartic transaminase[AST]121 U/L),higher WBC count(16.6×10^9/L)and higher CRP(213 mg/dL).His left knee joint swelling progressed,and the pain worsened.A magnetic resonance imaging scan of his left knee revealed edema of the bone marrow in the distal femur as well as joint effusion[Figure 1C].Meanwhile,the skin lesions increased in number and became larger,and some of the lesions ruptured and discharged pus[Figure 1D].Bronchoscopy results revealed a neoplasm in the left lingular bronchus(B4+B5),and tissue biopsy reported suspicious spore-like substances.Because of the difficulty of diagnosis,the patient was transferred to the Respiratory Department,First Affiliated Hospital,School of Medicine,Zhejiang University on May 28th,2018.On admission,we thoroughly reviewed his medical history and learned that he had lived in Vermont,which is located in the northeastern United States.For 4 years,the patient had not traveled outside Vermont.Physical examination findings included a low fever of 37.8℃,positive floating patella test in the left knee joint,and clusters of skin lesions,presenting as swellings,pustules,ruptures,and incrustations on the lower limbs.No abnormal breathing sounds or rales were heard.
