Anti-synthetase syndrome (AS) is a rare autoimmune idiopathic inflammatory myopathy (IIM) with diverse manifestations, including arthritis, interstitial lung disease (ILD), Raynaud’s phenomenon, unexplained persistent fever, and mechanic’s hands. We present the case of a 72-year-old woman, previously healthy, who was admitted to our hospital for treatment of cough and rapid breathing. The patient had elevated white blood cells and C-reactive protein, and tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). She was initially diagnosed with community-acquired pneumonia and received tamoxifen for anti-infection treatment, but her dystonia worsened. She eventually required non-invasive ventilator support, tested positive for SARS-Cov-2 again, and started antiviral therapy, corticosteroids to reduce alveolar effusion, anticoagulation, and other treatments. However, her condition continued to deteriorate, with the lowest oxygenation index reaching only 80mmHg. Ultimately, she underwent tracheal intubation and mechanical ventilation. Chest CT revealed rapid progressive interstitial changes in her lungs, and her hands showed noticeable fraternization changes. At this point, we suspected that the novel coronavirus infection might be associated with autoimmune diseases. The patient’s autoimmune antibody spectrum showed positive results for anti-recombinant RO-52 antibody and myositis-specific antibody anti-alanyl tRNA synthetase (anti-PL-12). The patient was treated with dexamethasone sodium phosphate for anti-inflammatory and anti-fibrotic effects. After successful extubation, the patient was discharged with only oral prednisone tablets at a dose of 30 mg. This case presents an early diagnosis and successful treatment of anti-synthetase syndrome combined with SARS-Cov-2 infection, emphasizing the importance of comprehensive physical examination. Additionally, it highlights the rapid progression of interstitial lung disease under SARS-Cov-2 infection, which is often difficult to distinguish on imaging. In cases where treatment for SARS-Cov-2 infection is ineffective, early screening for autoimmune diseases is recommended. As there is currently no standardized method for treating AS-ILD, the successful treatment of this case provides a reference for clinical research on anti-synthetase syndrome in the later stage.

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与 SARS-Cov-2 感染相关的抗合酶综合征

抗合成酶综合征（AS）是一种罕见的自身免疫性特发性炎症性肌病（IIM），具有多种表现，包括关节炎、间质性肺病（ILD）、雷诺现象、不明原因持续发热和机械手。我们介绍一名 72 岁女性的病例，她之前身体健康，因咳嗽和呼吸急促而入院治疗。该患者的白细胞和 C 反应蛋白升高，严重急性呼吸综合征冠状病毒 2 (SARS-Cov-2) 检测呈阴性。她最初被诊断为社区获得性肺炎，并接受他莫昔芬抗感染治疗，但肌张力障碍恶化。她最终需要无创呼吸机支持，再次检测出 SARS-Cov-2 呈阳性，并开始抗病毒治疗、皮质类固醇以减少肺泡积液、抗凝等治疗。然而，她的病情持续恶化，氧合指数最低仅达到80mmHg。最终，她接受了气管插管和机械通气。胸部 CT 显示她的肺部出现快速进行性间质变化，她的双手出现明显的兄弟化变化。此时，我们怀疑新型冠状病毒感染可能与自身免疫性疾病有关。该患者的自身免疫抗体谱显示抗重组RO-52抗体和肌炎特异性抗体抗丙氨酰tRNA合成酶（抗PL-12）呈阳性结果。该患者接受了地塞米松磷酸钠的抗炎和抗纤维化作用治疗。成功拔管后，患者仅口服泼尼松片30 mg出院。该病例体现了抗合成酶综合征合并SARS-Cov-2感染的早期诊断和成功治疗，强调了全面体检的重要性。此外，它强调了 SARS-Cov-2 感染下间质性肺疾病的快速进展，这通常很难通过影像学来区分。如果 SARS-Cov-2 感染治疗无效，建议尽早筛查自身免疫性疾病。由于目前治疗AS-ILD尚无标准化方法，本例的成功治疗为后期抗合成酶综合征的临床研究提供了参考。