Tocilizumab treatment for high-altitude antisynthetase syndrome-associated interstitial lung disease complicated by rectus sheath hematoma: A case report
Abstract
Abstract Introduction: Anti-Jo-1 antibody-positive antisynthetase syndrome (ASS) is frequently complicated by interstitial lung disease (ILD), and some patients respond poorly to glucocorticoids. The impact of chronic high-altitude hypoxia on the progression of ASS-ILD remains poorly documented. Tocilizumab (TCZ) has shown efficacy in refractory ASS-ILD; however, TCZ-induced hypofibrinogenemia when combined with anticoagulation may increase bleeding risk. Moreover, persistent elevation of creatine kinase (CK) after treatment is often attributed to ongoing myositis activity, but local tissue injury can also cause marked CK elevation and may influence therapeutic decisions. To the best of our knowledge, this is the first report of TCZ treatment for ASS-ILD in a patient residing at high altitude, documenting a life-threatening rectus sheath hematoma associated with TCZ-induced hypofibrinogenemia during concurrent anticoagulation. Case presentation: A 54-year-old Tibetan woman living at high altitude(3,650m) presented with a 7-day history of dry cough, dyspnea, and fatigue. Initial methylprednisolone treatment was effective; however, after discontinuation, she rapidly developed acute respiratory distress syndrome requiring endotracheal intubation. Anti-Jo-1 antibody positivity confirmed the diagnosis of ASS-ILD. Re-administration of methylprednisolone was ineffective. After a single intravenous dose of TCZ, pulmonary lesions improved markedly, but fibrinogen levels continued to…
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