Caught Between Fire and Flood: Navigating Anti-Synthetase Syndrome, ILD, and Dengue in a Spiraling Storm

We report a complex case of a middle-aged female with interstitial lung disease (ILD), rheumatoid arthritis, and hypothyroidism who presented with dengue fever. Her course was complicated by leukopenia, thrombocytopenia, and acute respiratory distress syndrome (ARDS) on the background of ILD. Overlapping features of dengue and autoimmune disease delayed recognition of underlying Anti-Synthetase Syndrome, a rare autoimmune disorder characterized by ILD, arthritis, and myositis-specific antibodies. Initiation of immunosuppressive therapy was deferred due to dengue-associated cytopenias, posing significant management challenges. After stabilization, she was started on cyclophosphamide with gradual improvement. This case underscores the diagnostic dilemmas and therapeutic challenges of managing tropical infections in patients with underlying autoimmune disease.