Persistent fever: Anti-KS syndrome overlaps with multidrug-resistant infections (MDRO) in a cervical spinal cord injury (CSCI) patient

A 62-year-old male patient with cervical spinal cord injury, developed multidrug-resistant Acinetobacter baumannii pneumonia, Klebsiella pneumoniae infection, Clostridium difficile colitis and intestinal candidiasis. Despite targeted antibacterial drug treatment and some radiological improvements, he still experienced persistent fever and watery diarrhea. A careful re-examination revealed the mechanic's hand. High-resolution computed tomography (HRCT) showed interstitial lung disease (ILD) and anti-asparaginyl-tRNA synthetase (anti-KS) antibodies were identified upon laboratory evaluation. Corticosteroid treatment led to rapid fever recurrence when tapered. Mycophenolate mofetil was added to stabilize the condition, gradually reducing steroids and eliminating the recurrence of fever after discontinuing antibiotics. This case highlights the diagnostic challenges of differentiating infection from autoimmune inflammation in critically ill patients and emphasizes the need to consider anti-KS antibody-positive antisynthetase syndrome (ASS) when persistent fever and gastrointestinal symptoms coexist with ILD.