CTICasesAnti-Synthetase Syndrome presenting as Organizing Pneumonia
Imaging findings
Serial chest CTs over several months demonstrate bilateral, symmetric ground-glass and consolidative opacities with a peri-lobular, subpleural, and lower-lung predominant distribution, typical of an organizing pneumonia (OP) or NSIP/OP overlap pattern. Hand examination revealed 'mechanic's hands,' prompting a Myositis panel that was positive for PL-12 antibodies.
Key takeaways
Anti-synthetase syndrome is an autoimmune connective tissue disease characterized by interstitial lung disease, Myositis, arthritis, Raynaud's phenomenon, and 'mechanic's hands' (hyperkeratosis and scaling of the palms and fingers). The typical pulmonary manifestation is an organizing pneumonia (OP) or NSIP pattern; recognizing extrapulmonary physical findings such as mechanic's hands can prompt the correct serological workup (Myositis panel for antibodies like Jo-1, PL-12, PL-7) and avoid misclassifying the disease as a drug reaction or idiopathic process.
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