Spontaneous Remission In A Patient With Anti-oj Autoantibodies-positive Anti-synthetase Syndrome Following Sars-cov-2 Infection And Mrna Vaccination: A Case Report
Todoroki, Y., Nakayamada, S., Miyagawa, I., Kubo, S., Yoshioka, K., Satoh, M., & Tanaka, Y. (2025). Spontaneous Remission in a Patient with Anti-OJ Autoantibodies-positive Anti-synthetase Syndrome Following SARS-CoV-2 Infection and mRNA Vaccination: A Case Report. Internal medicine (Tokyo, Japan), 10.2169/internalmedicine.4852-24. Advance online publication. https://doi.org/10.2169/internalmedicine.4852-24
View Original Source →Abstract
Anti-synthetase syndrome (ASyS) is a subset of idiopathic inflammatory myopathies characterized by a triad of myositis, interstitial lung disease, and arthritis. Patients with ASyS are generally treated with glucocorticoids, immunosuppressants, or both. We encountered a 53-year-old woman who developed anti-OJ autoantibodies-positive anti-synthetase syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and CoV-2 messenger RNA (mRNA) vaccination. Her dyspnea and rash resolved within 4 weeks of the initial examination, achieving spontaneous remission without treatment 52 weeks after the diagnosis. This case suggests a potential association between SARS-CoV-2 infection, mRNA vaccination, and the transient development of anti-OJ antibodies-positive ASyS.
Case Details
Disease Location
Skin, lungs
Personal Characteristics
53-year-old woman. History of mild covid-19 5 months prior to consultation.
Clinical Characteristics
She received the third dose of the sars-cov-2 mrna vaccine 14 weeks after the infection. Her dyspnea and dry cough worsened two weeks after vaccination (four weeks before consultation). Chest (CT) revealed diffuse consolidation in the bilateral lower lung lobes. Erythema was observed on the fingers of both hands and extensor surfaces of both elbows, and laboratory testing demonstrated elevated myogenic enzyme levels. These findings suggested dermatomyositis. She exhibited gottron’s papules, mechanic’s hands, periungual erythema in the fingers of both hands, and gottron’s sign over both knees. A skin biopsy of the gottron’s papules confirmed hyperkeratosis, parakeratosis, and liquefaction degeneration, with the presence of perivascular lymphocyte infiltrates in the upper dermis, all of which were consistent with dermatomyositis. Laboratory tests revealed elevated levels of a myogenic enzyme. Anti-nuclear antibody testing using indirect immunofluorescence (ana) confirmed a cytoplasmic pattern, and immunoprecipitation (ip) revealed the presence of anti-oj antibodies. Chest radiography and high-resolution (hr)-CT showed extensive consolidation and ground-glass opacities, mainly in the bilateral lower lung lobes. During bronchoscopy, lymphocyte-predominant bronchoalveolar lavage fluid was collected. Severe lymphocytic infiltration around the alveolar septa and polypoid fibrosis (masson’s bodies) were observed. These findings were considered consistent with the cellular non-specific interstitial pneumonia (c-nsip) and organizing pneumonia (op) patterns. She was diagnosed with anti-synthetase syndrome (asys).
Remission Characteristics
The patient noted apparent relief of dermatological and respiratory symptoms two weeks before the final diagnosis.
Treatment & Mechanisms
Clinical Treatment
Sars-cov-2 mrna vaccine skin biopsy