Therapeutic plasma exchange in antisynthetase syndrome with severe interstitial lung disease.
Antisynthetase syndrome (ASS) is a rare condition characterized by interstitial lung disease (ILD), inflammatory myositis, fever, Raynaud phenomenon, mechanic's hand, and inflammatory polyarthritis in the setting of antibodies to amino acyl-transfer RNA synthetases, with anti-Jo-1 antibody being the most common. Prognosis is very poor especially when there is associated ILD. To date, there is no standardized treatment for ILD associated ASS. Therapy is based on the use of steroids alone or in combination with other immunosuppressive agents, especially in severe or refractory cases. The role of therapeutic plasma exchange (TPE) in the management of this rare condition has not been established. Here, we report a case of severe ILD associated ASS in a 41-year-old woman who did not show clinical or laboratory response after six doses of high dose steroids and a dose of IV cyclophosphamide. Because of the aggressive nature of her disease and poor prognostic indices present, a decision was made to add TPE to her treatment. She underwent five sessions of TPE. At the end of the 5th session, the anti-Jo-1 antibody levels dropped to 3.6 AI (antibody index) and her creatinine kinase (CK) level from 875 to 399 U L(-1) (Units per liter) with overall improvement in her respiratory status. This case suggests TPE may be a promising treatment option in patients with ILD associated ASS refractory to steroids and other immunosuppressive therapy, particularly those with severe disease.
Division of Nephrology, University of Virginia, Charlottesville, Virginia.|Department of Medicine, Obafemi Awolowo University Teaching Hospitals' Complex, Ile - Ife, Osun State, Nigeria.
Bolanle A
BA
Omotoso
School of Medicine, University of Virginia, Charlottesville, Virginia.
Melissa I
MI
Ogden
Division of Nephrology, University of Virginia, Charlottesville, Virginia.
Rasheed A
RA
Balogun
D000328:Adult; D000604:Amino Acyl-tRNA Synthetases / Q000276:immunology; D000974:Antibodies, Antinuclear / Q000097:blood / Q000302:isolation & purification; D005260:Female; D006643:Histidine-tRNA Ligase / Q000276:immunology; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000201:enzymology / Q000276:immunology / Q000628:therapy*; D009220:Myositis / Q000201:enzymology / Q000276:immunology / Q000628:therapy*; D010951:Plasma Exchange; D013577:Syndrome; D016896:Treatment Outcome
D000974:Antibodies, Antinuclear; C046750:Jo-1 antibody; D000604:Amino Acyl-tRNA Synthetases; D006643:Histidine-tRNA Ligase
antisynthetase syndrome; interstitial lung disease; therapeutic plasma exchange