Atypical Presentation of Dysphagia in a Patient Diagnosed Later With Dermatomyositis: A Case Report

Elmdaah, Ali; Ali, Abuobeida; Nadeem, Zulakha; Habieb, Mohamed; Pradeep, John; Metangi, Kevin

doi:10.7759/cureus.19964

Cited by 3 publications

(2 citation statements)

References 11 publications

(11 reference statements)

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“…Persistent complaints of dysphagia in such patients of dermatomyositis might be considered for IV immunoglobulins infusion or other second-line immunosuppressants [ 12 ]. A recent research study utilizing both videofluoroscopic swallow study (VFSS) and manometry concluded that dysphagia observed in patients with inflammatory myopathy is primarily caused by weakened pharyngeal muscle contractions, which is linked to the weakness of the suprahyoid muscles [ 13 ]. Therefore, swallowing rehabilitation therapies like oropharyngeal exercises and compensation techniques would be more effective in managing the condition [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Dermatomyositis Masquerading As Generalized Body Swelling: A Case Report

Sunny,

Kashyap,

Kumar

et al. 2023

Cureus

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Dermatomyositis (DM) is a systemic autoimmune disease that primarily affects the skin and muscles. The hallmark skin manifestation is a violaceous rash on the face, neck, shoulders, upper chest, and extensor surfaces of the arms and legs, which is often accompanied by edema and can be exacerbated by exposure to sunlight. Generalized limb edema and dysphagia are rare presentations of dermatomyositis. Here we present a case of a 69-year-old woman presenting with generalized limb swelling, periorbital swelling, and dysphagia which was diagnosed as dermatomyositis based on a combination of clinical, laboratory, and imaging findings. The patient had an absence of complaints of limb weakness and a predominance of complaints of edema and dysphagia which posed a diagnostic challenge. The patient was treated with high-dose steroids and immunosuppressive therapy, leading to a significant improvement in her symptoms. Edematous dermatomyositis has been associated with underlying malignancy in 25% of the cases and this warrants close follow-up and malignancy screening for such patients. In some cases, subcutaneous edema might be the only manifestation of the disease. This case underscores the importance of recognizing DM as a potential differential diagnosis in patients presenting with generalized edema and dysphagia, particularly in the initial absence of classic skin findings. This rare presentation of dermatomyositis may be a hallmark of a severe form of the disease and requires prompt recognition and aggressive treatment.

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Section: Discussionmentioning

confidence: 99%

Dermatomyositis Masquerading As Generalized Body Swelling: A Case Report

Sunny,

Kashyap,

Kumar

et al. 2023

Cureus

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show abstract

“…6,7 The clinical manifestations of dysphagia vary across patients with DM, making the diagnosis and management challenging. Studies have reported that dysphagia can present as an initial symptom, 8,9 or occur progressively over the course of the disease. 10,11 To date, dysphagia in patients with DM remains poorly understood.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta‐analysis on the prevalence and clinical characteristics of dysphagia in patients with dermatomyositis

Cheng

Wong

2023

Neurogastroenterology Motil

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BackgroundDermatomyositis (DM) is a rare autoimmune disease characterized by distinctive skin rash, muscle inflammation with symmetrical and progressive muscle weakness, and elevated serum levels of muscle‐associated enzymes. DM may affect skeletal muscles involved in swallowing, leading to dysphagia, which can negatively impact individual's physical and psychosocial well‐being. Despite this, dysphagia in patients with DM remains poorly understood. This systematic review and meta‐analysis aimed to evaluate the prevalence and clinical features of dysphagia in patients with DM and juvenile DM (JDM).MethodsFour electronic databases were systematically searched until September 2022. Studies with patients with DM or JDM and dysphagia were included. The pooled prevalence of all included studies was calculated, and the clinical characteristics of dysphagia were qualitatively analyzed.Key ResultsThirty‐nine studies with 3335 patients were included. The overall pooled prevalence of dysphagia was 32.3% (95% CI: 0.270, 0.373) in patients with DM and 37.7% (95% CI: −0.031, 0.785) in patients with JDM. Subgroup analyses revealed that Sweden had the highest prevalence (66.7% [95% CI: 0.289, 1.044]), whereas Tunisia had the lowest prevalence (14.3% [95% CI: −0.040, 0.326]). Moreover, South America had the highest prevalence (47.0% [95% CI: 0.401, 0.538]), whereas Africa had the lowest prevalence (14.3% [95% CI: −0.040, 0.326]). Dysphagia in patients with DM and JDM was characterized by both oropharyngeal and esophageal dysfunctions, with predominant difficulties in motility.Conclusions & InferencesOur findings showed that dysphagia affects one in three patients with DM or JDM. However, the documentation on the diagnosis and management of dysphagia in the literature is inadequate. Our results highlighted the need to use both clinical and instrumental assessments to evaluate swallowing function in this population.

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Dermatomyositis Presenting with Isolated Dysphagia: A Case Report

Lee¹,

Lee²,

Choi³

et al. 2022

Korean J Neuromuscul Disord

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We report a case of a 75-year-old woman who was diagnosed with dermatomyositis presenting with isolated dysphagia. There were no obvious cranial nerve deficits with normal motor grade in all the limbs in neurological examinations, but a suspicious rash was observed in the anterior chest. The serum creatine kinase was 306 IU/L, and active myopathic changes in bilateral limb muscles were observed in the electromyography test. Muscle biopsy from vastus lateralis showed perivascular infiltration of mononuclear inflammatory cells, which was compatible with dermatomyositis. She had responded to oral prednisolone and azathioprine.

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Atypical Presentation of Dysphagia in a Patient Diagnosed Later With Dermatomyositis: A Case Report

Cited by 3 publications

References 11 publications

Dermatomyositis Masquerading As Generalized Body Swelling: A Case Report

Dermatomyositis Masquerading As Generalized Body Swelling: A Case Report

A systematic review and meta‐analysis on the prevalence and clinical characteristics of dysphagia in patients with dermatomyositis

Dermatomyositis Presenting with Isolated Dysphagia: A Case Report

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