Nailing the Diagnosis – Anti-Synthetase Syndrome as a Cause for Pyrexia of Unknown Origin

A 67-year old Hainanese homemaker with a past medical history of hypertension presented with a two-month history of quotidian fever of 38-39°C associated with a truncal maculopapular rash (Figure 1). She did not have significant contact or travel history. She discharged against medical advice after a three-day admission due to cost issues. She re-presented a month later with persistent fever and a one-week history of productive cough associated with symptoms of fluid overload. The rash had resolved by this time.