B43-26 Anti-Ro52 Antibodies as a Marker of Disease Severity in Interstitial Lung Disease: A Case Report

Abstract Ro52 (TRIM21) is a ubiquitin ligase that contributes to integral immunological responses such as antibody-dependent neutralization. Accordingly, autoantibodies resulting from irregular expression of Ro52 can lead to systemic autoimmune disorders. Such autoimmune processes manifest in organ-specific damage, including pulmonary involvement. Here, I present a case of interstitial lung disease and the implications of anti-Ro52 on survival. On initial presentation to the emergency department, this 76 year-old-female with history of fibromyalgia and asthma reported one month of progressively worsening dyspnea. Vital signs on admission included blood pressure 109/72, heart rate 66, respiratory rate 21, 90% saturation on 55% FiO2 high flow nasal cannula. Physical examination revealed increased work of breathing, bibasilar crackles, nails without clubbing. Lab work was remarkable for WBC 12 K/uL, pro-calcitonin 0.10, CRP 12.4 mg/L, infectious respiratory panel negative. Subsequent CT imaging revealed extensive pulmonary fibrotic changes, mild-to-moderate interstitial pulmonary edema, and congestive heart failure. Trial of furosemide 40 mg IV and high-dose pulse therapy (1g methylprednisolone IV for three days) yielded modest decrease in respiratory needs, the latter of which prompted investigation into autoimmune etiology. As such, rheumatologic and myositis panels revealed that patient was found to have positive Ro52 antibody (133 AU/mL), SS-A antibody (8.0 AI). Following transition to oral corticosteroid regimen of prednisone 60 mg on hospital day 6, repeat CT to compare to baseline was obtained which showed mild interval improvement in interlobular septal thickening and groundless opacities. She was started on rituximab 1 g for two doses, two weeks apart. On hospital day 15, patient has improved to requiring 5 L nasal cannula O2. There is a growing body of literature demonstrating the correlation between anti-Ro52 and worse clinical outcomes. Recognition of the anti-Ro52 as a potential marker of disease severity may inform clinical management and provide a framework for prognostication. Ultimately, awareness of the clinical implications of Ro52 positivity can lead to more timely interventions and optimization of outcomes in patients with autoimmune-related interstitial lung disease. This abstract is funded by: none