Global Myocardial Edema in Antisynthetase Syndrome Detected by Cardiovascular Magnetic Resonance Mapping Techniques

A 56-year-old man presented with 7 months of fever, breathlessness, cough, and proximal muscle weakness with tenderness. His medical history was hypertension. His examination was unremarkable except for peripheral edema and a new, scaly, fissured erythematous rash on the hands and fingers (Figure 1). Blood tests revealed normocytic anemia, low total protein, raised inflammatory markers (C-reactive protein, 59 mg/L [normal, 0–5 mg/L]; erythrocyte sedimentation rate, 43 mm/h [normal, 1–20 mm/h]), and negative infective screen. The ECG was normal. Chest radiography and subsequent computed tomography showed interstitial lung disease. Echocardiography was normal (Movie IA in the online-only Data Supplement), but N-terminal pro-brain natriuretic peptide was very elevated at 245 …