Presentation
Breathlessness, fatigue and fever
Patient Data
Diffuse interstitial markings are noted with patchy consolidative change present throughout the lungs with a basal and peripheral predominance. There are no pleural effusions. Small pericardial effusion.
Diffuse coarse interstitial changes and alveolar infiltrate is noted in both lower zones, perhaps worse on the left base. There is a trace of pleural fluid on the left. The heart size and mediastinal contours are within normal limits.
Case Discussion
This is a lady with known anti-synthetase syndrome. She has anti-Jo (histidyl-rNTA synthetase) serology positive at the time of first diagnosis in 2020. She presented to Emergency with breathlessness without hypoxia as well as fatigue and a fever. She was treated with a burst of prednisolone, intravenous antibiotic therapy as well as PJP prophylaxis. She was later started on Tracrolimus and Mycophenolate for further immunosuppression in consultation with immunologists and respiratory physicians.