CTICasesAnti-Jo-1 Antisynthetase Syndrome
Imaging findings
A 36-year-old woman transferred with acute respiratory failure, initially attributed to smoke inhalation during nearby wildfires, shows symmetric bilateral lower lobe consolidation on CT, some of it nodular. A follow-up study weeks later after empiric antibiotics shows progression to more confluent lower lobe consolidation with organizing-pneumonia-type areas and mild airway dilation.
Key takeaways
Persistent, symmetric, basal-predominant consolidation unresponsive to antibiotics should raise concern for an underlying connective tissue disease rather than infection or smoke inhalation; this patient had a strong history of rheumatoid symptoms and tested positive for anti-Jo-1, confirming antisynthetase syndrome (with negative CCP and rheumatoid factor), and improved substantially on steroids. The pattern reflects a mix of NSIP and organizing pneumonia, and there is ongoing discussion about whether an environmental exposure such as smoke inhalation can precipitate manifestation of underlying autoimmune lung disease, as suggested by data from World Trade Center first responders.
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