Mechanic's hands in a patient with isolated anti‐Ro52 antibodies: antisynthetase syndrome without antisynthetase antibodies

Abstract

A 52-year-old female presented with an 8-month history of dyspnea, fever, muscle weakness, and arthralgia. Her past medical history was unremarkable. The patient did not report pruritus or a history of atopic disease or allergy. On clinical examination, we noted hyperkeratosis and fissures of the lateral aspects of fingers and fingertips consistent with mechanic’s hands (MH) (Figure 1a, b). She had symmetrically swollen and tender finger joints. The creatine kinase level and electrophysiological tests were normal. Testing for antinuclear antibodies (ANAs) revealed a speckled pattern with a titer of 1 : 320 and showed additional cytoplasmic fluorescence. Serological testing for antibodies yielded positive results for anti-Ro52 antibodies. Other antibodies to extractable nuclear antigens (ENAs), including anti-Ro60 (SS-A) antibodies as well as antisynthetase antibodies (anti-Jo1, anti-EJ, anti-OJ, anti-PL7 and anti-PL12) were negative on repeat testing. Computed tomography of the chest showed signs of interstitial lung disease (ILD) (Figure 1c, red arrowheads). Nailfold video capillaroscopy showed megacapillaries, elongations, and tortuosities consistent with a myositis pattern Clinical Letter