A 47-year-old man was referred to our hospital with a 1-month history of fever and dyspnea after inhalation of insecticide in a confined space. We diagnosed rapidly progressive interstitial pneumonia. High-dose methylprednisolone, tacrolimus, and intermittent infusion of cyclophosphamide were administered. His condition rapidly deteriorated; therefore, extracorporeal membrane oxygenation therapy was performed. Unfortunately, he died 69 days after admission. Although typical skin findings suggestive of dermatomyositis were absent, anti-melanoma differentiation-associate gene (anti-MDA5) antibody was positive. Our findings suggest that in patients with hyperferritinemia and rapidly progressive interstitial lung disease (RP-ILD) demonstrating random ground glass shadows and peripheral consolidations by high-resolution computed tomography (HRCT) even if skin manifestations related to dermatomyositis are not complicated, we should assume anti-MDA5 antibody-positive interstitial pneumonia.
Keywords: ARS, anti-aminoacyl-tRNA synthetase; Anti-MDA5, anti-melanoma differentiation-associate gene; Anti-melanoma differentiation-associated gene 5 antibody; CADM, clinically amyopathic dermatomyositis; Clinical amyopathic dermatomyositis; Extracorporeal membrane oxygenation; HRCT, high-resolution computed tomography; IVCY, intravenous cyclophosphamide; RIG-I, retinoic acid inducible gene-I; RP-ILD, rapidly progressive interstitial lung disease; Rapidly progressive interstitial pneumonia.