title: A case of anti-aminoacyl tRNA synthetase antibody syndrome complicated by hemophagocytic syndrome.
abstract: A 48-year-old woman had suffered from a fever and general fatigue, and visited the other hospital for fever elevation in November 2013, at which time interstitial lung disease was revealed. In January 2014, she experienced an eruption in the hand and developed peripheral blood flow damage. Under a diagnosis of adult Still's disease, the patient was administered 0.5 mg of betamethasone as well as cyclosporin at 75 mg/day. In November 2014, general fatigue, fever, and headache were noted, while MRI revealed an enlarged hypophysis and laboratory findings were positive for the anti-pituitary cell antibody, thus a diagnosis of autoimmune hypophysitis was made. Although disease activity was low, she requested hospitalization and was admitted by the Division of Endocrinology and Metabolism at our hospital in May 2015, though only observed. Fever developed again, along with interstitial lung disease, Raynaud's phenomenon, and pain in the crural area again, and we considered the possibility of another disease. After stopping administration of betamethasone and cyclosporin, we made a diagnosis of anti-aminoacyl tRNA synthetase antibody syndrome, and administered methylprednisolone at 500 mg for 3 days as well as prednisolone at 35 mg/day following steroid pulse therapy. Although her condition soon improved, fever, muscle pain, and pancytopenia returned after 3 days. Bone marrow findings revealed the existence of hemophagocytosis, for which we again gave methylprednisolone at 500 mg for 3 days and cyclosporin at 125 mg/day. Thereafter, the patient recovered and was discharged from the hospital.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine.
authors.forename: Kota
authors.initials: K
authors.lastname: Azuma
authors.forename: Masao
authors.initials: M
authors.lastname: Tamura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kurajoh
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hosono
authors.forename: Ran
authors.initials: R
authors.lastname: Nakajima
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Takeo
authors.initials: T
authors.lastname: Abe
authors.forename: Chie
authors.initials: C
authors.lastname: Ogita
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Furukawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Saito
authors.forename: Aki
authors.initials: A
authors.lastname: Nishioka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sekiguchi
authors.forename: Naoto
authors.initials: N
authors.lastname: Azuma
authors.forename: Masayasu
authors.initials: M
authors.lastname: Kitano
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tsunoda
authors.forename: Koichiro
authors.initials: K
authors.lastname: Omura
authors.forename: Hidenori
authors.initials: H
authors.lastname: Koyama
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Matsui
authors.forename: Tsuneyo
authors.initials: T
authors.lastname: Mimori
authors.forename: Hajime
authors.initials: H
authors.lastname: Sano
mesh_terms: D000604:Amino Acyl-tRNA Synthetases / Q000276:immunology*; D001327:Autoimmune Diseases / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D016572:Cyclosporine / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D020551:Pulse Therapy, Drug; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D016572:Cyclosporine; D011239:Prednisolone; D000604:Amino Acyl-tRNA Synthetases; D008775:Methylprednisolone