INTRODUCTIONAminoacyl tRNA synthetases (ARSs) are a group of cytoplasmic enzymes that bind to transcribed RNA during protein synthesis, esterify amino acids to transcribed RNA, and function as catalysts for aminoacyl-transcribed RNA.1 Patients who test positive for anti-ARS antibodies present with various extramuscular symptoms, such as interstitial pneumonia, mechanic’s hands, Raynaud phenomenon, polyarthritis, fever, and myositis. These symptoms share common clinical features, which led Targoff in 1992 to term them ”antisynthetase antibody syndrome.”2 Since Jo-1 (histidyl-tRNA synthetase: HisRS) antibody was discovered in 19803, eight ARS antibodies have been identified: histidyl-tRNA synthetase-1 (Jo-1), anti-threonyl (PL-7), anti-alanyl (PL-12), anti-glycyl (EJ), anti-isoleucyl (OJ) anti-asparaginyl (KS), anti-phenylalanyl (Zo) and anti-tyrosyl (Ha) tRNA synthetase4.5, 6 Among these antibodies, anti-OJ is the least prevalent (3.1%).7 Anti-OJ- positive anti-ARS syndrome is extremely rare, and is usually accompanied by interstitial pneumonia.8 Anti-OJ and anti-Sjögren’s-syndrome-related antigen A (Ro-52) antibodies are occasionally detected in patients with dermatomyositis and are a poor prognostic factor when associated with interstitial pneumonia.9 However, we encountered a patient with OJ-and Ro-52 positive anti-ARS syndrome without interstitial pneumonia and with severe phalanx necrosis due to Raynaud phenomenon. The activity of disease could be suppressed with steroid pulse therapy. We believe that this is an atypical clinical presentation that deserves acknowledgement by means of this case report. We also report it here with a review of the literature.

INTRODUCTIONAminoacyl tRNA synthetases (ARSs) are a group of cytoplasmic enzymes that bind to transcribed RNA during protein synthesis, esterify amino acids to transcribed RNA, and function as catalysts for aminoacyl-transcribed RNA.1 Patients who test positive for anti-ARS antibodies present with various extramuscular symptoms, such as interstitial pneumonia, mechanic’s hands, Raynaud phenomenon, polyarthritis, fever, and myositis. These symptoms share common clinical features, which led Targoff in 1992 to term them ”antisynthetase antibody syndrome.”2 Since Jo-1 (histidyl-tRNA synthetase: HisRS) antibody was discovered in 19803, eight ARS antibodies have been identified: histidyl-tRNA synthetase-1 (Jo-1), anti-threonyl (PL-7), anti-alanyl (PL-12), anti-glycyl (EJ), anti-isoleucyl (OJ) anti-asparaginyl (KS), anti-phenylalanyl (Zo) and anti-tyrosyl (Ha) tRNA synthetase4.5, 6 Among these antibodies, anti-OJ is the least prevalent (3.1%).7 Anti-OJ- positive anti-ARS syndrome is extremely rare, and is usually accompanied by interstitial pneumonia.8 Anti-OJ and anti-Sjögren’s-syndrome-related antigen A (Ro-52) antibodies are occasionally detected in patients with dermatomyositis and are a poor prognostic factor when associated with interstitial pneumonia.9 However, we encountered a patient with OJ-and Ro-52 positive anti-ARS syndrome without interstitial pneumonia and with severe phalanx necrosis due to Raynaud phenomenon. The activity of disease could be suppressed with steroid pulse therapy. We believe that this is an atypical clinical presentation that deserves acknowledgement by means of this case report. We also report it here with a review of the literature.

CASE REPORTOccurrence of adult-onset Still’s disease aftercoronavirus disease 2019 BNT162B2 vaccination in a patient with ulcerative colitisTakahiro Kobayashi1, MD | Kenichi Hashimoto1, MD, PhD | Yasuyoshi Kusanagi2, MD | Yuji Tanaka1, MD, PhD1Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama359-8513, Japan2Department of Internal Medicine, Division of Hematology and Rheumatology, National Defense Medical College, Tokorozawa, 359-8513 Saitama, JapanCorrespondence: Kenichi Hashimoto, Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.Tel: +81-429-95-1211 (ext. 3633); Fax: +81-429-91-1238Email:[email protected] AVAILABILITY STATEMENTNot applicable.FUNDING STATEMENTThis work was supported by the Fukuda Foundation for Medical Technology (2019).CONFLICT OF INTEREST DISCLOSUREThe authors report no conflict of interest.ETHICS APPROVAL STATEMENTThe study was approved by the Competent Authorities and Ethics Committees of National Defense Medical College (approval no. 4609). Written informed consent was obtained from all patients.PATIENT CONSENT STATEMENTPublished with written consent of the patient.PERMISSION TO REPRODUCE MATERIAL FROM OTHER SOURCESNot applicableCLINICAL TRIAL REGISTRATIONNot applicable

Inguinal hernia may contain the bladder as one of its contents, while bilateral inguinal bladder herniation is rare. Urinary obstruction and obesity are associated with increased abdominal pressure and are risk factors of bladder herniation. Clinicians should be aware of the bladder hernia in elderly with chronic dysuria and obesity.