Images in Clinical Rheumatology
Antisynthetase Syndrome and Influenza B, Characteristic Pulmonary Involvement
Síndrome antisintetasa e influenza B, afectación pulmonar característica
Roberto Hurtado García
, Beatriz Hurtado Oliver, Eric Nortes Cañizares, José Maria Cepeda Rodrigo
Corresponding author
Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, Spain
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(B) Axial slice of magnetic resonance of the pelvis. Short-tau inversion recovery (STIR) sequence, with hyperintense signal in both sacroiliac joints. (C) Computed tomography, axial image, of pelvis, showing the vacuum phenomenon in right sacroiliac joint, as well as calcification in fibrocartilage of both sacroiliac joints, with osteophytes.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maria Jose Moreno Martinez, Manuel J. Moreno Ramos, Luis F. Linares Ferrando" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Maria Jose" "apellidos" => "Moreno Martinez" ] 1 => array:2 [ "nombre" => "Manuel J." "apellidos" => "Moreno Ramos" ] 2 => array:2 [ "nombre" => "Luis F." 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She was being treated with azathioprine, etanercept and prednisone, at a dose of 15<span class="elsevierStyleHsp" style=""></span>mg/day that was being tapered. She was admitted to the hospital with manifestations of an increase in her usual dyspnea, fever of 38.5<span class="elsevierStyleHsp" style=""></span>°C and yellowish expectoration. With these findings, we requested that she undergoes lung computed tomography, which revealed the presence of recently developed patchy ground-glass opacities. Given the clinical context, we were obliged to rule out superinfection; we also observed areas of fibrotic scar in middle and lower fields, in the form of subpleural interstitial thickening, traction bronchiectasis and bronchiolectasis. She underwent serological tests for cytomegalovirus, Epstein–Barr virus and varicella zoster, which were negative. There were no microorganisms in her sputum. However, polymerase chain reaction for influenza B virus was positive. The patient was treated with antibiotic therapy consisting of piperacillin-tazobactam combined with oseltamivir. Her clinical response was good, as is shown by the radiological improvement, illustrated by the serial images (A initial findings, B with patchy infiltrations and C showing resolution) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The population of immunocompromised patients has increased in recent years. This has been accompanied by those having the associated infectious complications, especially, pneumonia (approximately 75% of these infections<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a>). The agents that cause pneumonia in these patients, may be the same as those reported in immunocompetent individuals (although it is associated with higher rates of morbidity and mortality), that is to say, viruses like influenza, cytomegalovirus, herpes simplex and varicella zoster.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Complications due to influenza virus occur more often in elderly and diabetic patients, as well as in individuals with renal dysfunction or immunosuppressive therapy. Their clinical manifestations are diffuse in the initial phases and become worse as the diseases advance. In radiological terms, they are characterized by diffuse interstitial infiltrates.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Although this case report corresponds to what we may observe in routine clinical practice, we have found no similar cases described in the literature.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-09-28" "fechaAceptado" => "2016-11-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hurtado García R, Hurtado Oliver B, Nortes Cañizares E, Cepeda Rodrigo JM. Síndrome antisintetasa e influenza B, afectación pulmonar característica. Reumatol Clin. 2018;14:173–174.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 618 "Ancho" => 1900 "Tamanyo" => 211957 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Serial computed tomography scans taken in the axial plane: (A) initial phase, (B) high point of the process and (C) resolution.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The figure shows small bilateral patchy ground-glass opacities, predominantly in the periphery, as a key finding (arrows), and a slight thickening of the interstitium between lobes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary infections in immunocompromised hosts: the importance of correlating the conventional radiologic appearance with the clinical setting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.W. Oh" 1 => "E.L. Effmann" 2 => "J.D. Godwin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.217.3.r00dc35647" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2000" "volumen" => "217" "paginaInicial" => "647" "paginaFinal" => "656" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11110924" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and radiographic comparison of influenza virus-associated pneumonia among three viral subtypes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Ishiquro" 1 => "N. Takayanagi" 2 => "T. Kanauchi" 3 => "R. Uozumi" 4 => "E. Kawate" 5 => "Y. Takaku" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2169/internalmedicine.55.5227" "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "731" "paginaFinal" => "737" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27041156" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peculiarities of clinical and X-ray picture of pneumonia in patients with influenza A (H1N1)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O.M. Serebioakova" 1 => "E.N. Romanova" 2 => "A.V. Govorin" 3 => "A.P. Filev" 4 => "A.S. Shangin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Klin Med (Mosk)" "fecha" => "2012" "volumen" => "90" "paginaInicial" => "70" "paginaFinal" => "72" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001400000003/v1_201805120507/S2173574318300455/v1_201805120507/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001400000003/v1_201805120507/S2173574318300455/v1_201805120507/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318300455?idApp=UINPBA00004M" ]
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| 2022 July | 68 | 48 | 116 |
| 2022 June | 44 | 33 | 77 |
| 2022 May | 43 | 32 | 75 |
| 2022 April | 42 | 54 | 96 |
| 2022 March | 41 | 41 | 82 |
| 2022 February | 41 | 26 | 67 |
| 2022 January | 37 | 51 | 88 |
| 2021 December | 40 | 47 | 87 |
| 2021 November | 40 | 47 | 87 |
| 2021 October | 54 | 51 | 105 |
| 2021 September | 41 | 39 | 80 |
| 2021 August | 25 | 42 | 67 |
| 2021 July | 25 | 22 | 47 |
| 2021 June | 30 | 30 | 60 |
| 2021 May | 47 | 35 | 82 |
| 2021 April | 108 | 77 | 185 |
| 2021 March | 62 | 39 | 101 |
| 2021 February | 25 | 21 | 46 |
| 2021 January | 41 | 22 | 63 |
| 2020 December | 41 | 26 | 67 |
| 2020 November | 43 | 20 | 63 |
| 2020 October | 22 | 19 | 41 |
| 2020 September | 40 | 27 | 67 |
| 2020 August | 33 | 20 | 53 |
| 2020 July | 14 | 17 | 31 |
| 2020 June | 44 | 24 | 68 |
| 2020 May | 26 | 25 | 51 |
| 2020 April | 20 | 31 | 51 |
| 2020 March | 27 | 6 | 33 |
| 2020 February | 1 | 0 | 1 |
| 2019 May | 1 | 0 | 1 |
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