Abstract
Bronchiectasis is a chronic airway disease that may be underrecognized when its manifestations overlap with pulmonary tuberculosis (TB) and interstitial lung disease (ILD). We report a 45-year-old woman presenting with chronic productive cough, progressive dyspnea, recurrent respiratory infections and weight loss who was initially treated as pulmonary TB despite negative molecular testing and minimal clinical improvement. High-resolution computed tomography (HRCT) revealed extensive bilateral cystic bronchiectasis, ground-glass opacities, centrilobular nodules and honeycombing suggestive of fibrotic ILD. Pulmonary function testing demonstrated a restrictive ventilatory defect, while immunoserological evaluation showed positive anti-Jo-1, anti-Mi-2 alpha and anti-HMGCR antibodies, supporting the diagnosis of anti-synthetase-associated ILD. The clinical course was complicated by recurrent pulmonary exacerbations, with sputum cultures repeatedly isolating Escherichia coli, indicating persistent airway infection and bacterial colonization. Management posed a significant therapeutic challenge because immunosuppressive therapy required for ILD control carried the risk of worsening chronic bronchiectatic infection. Therefore, treatment focused on culture-guided antibiotics, bronchodilator therapy, airway clearance, chest physiotherapy, nutritional support and multidisciplinary monitoring before considering definitive immunosuppressive therapy. This case highlights the importance of early recognition of autoimmune-associated ILD in patients with nonresolving bronchiectasis exacerbations to reduce diagnostic delay, prevent progressive pulmonary fibrosis and optimize individualized multidisciplinary management in complex respiratory overlap syndromes, particularly in resource-limited healthcare settings.
Keywords: Anti-synthetase Syndrome, Bronchiectasis, Interstitial Lung Disease, Recurrent Exacerbation.