Case report: atypical anti-SAE1 autoantibody manifestation with splinter hemorrhages as onset, and related to urothelial cancer

A. Biglia, M.C. Sacchi, F. Maggiore, V. Morandi, E. Cammarata, M.M. Ciriello, M.R. Pellico, L. Agatea, C. Pelazza, A. Roveta, L.M. Castello

SC Internal Medicine, University Hospital “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy. carolina.pelazza@aou.al.it 

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• Autoimmunity

BACKGROUND: Subungual splinter hemorrhages may represent an expression of infective endocarditis as well as autoimmune diseases or neoplasms. Anti-SAE1 autoantibody is directed against a small ubiquitin-like modifier-activating enzyme that plays a role in regulating transcription, cell cycle, and apoptosis. It is specific for dermatomyositis with skin rash and mild muscle involvement, and it can be associated with cancer. 

CASE REPORT: We describe the case of a patient who developed subungual splinter hemorrhages and acrocyanosis. Infections were excluded, and autoimmunity resulted in anti-SAE1 autoantibodies. A cancer screening found a high-grade urothelial carcinoma. The splinter hemorrhages disappeared after the carcinoma enucleation. 

CONCLUSIONS: Our case describes an atypical onset of anti-SAE1 dermatomyositis with splinter hemorrhages, potentially linked to urothelial cancer. This highlights the importance of comprehensive cancer screening in patients with unusual dermatomyositis presentations 

 

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