Oropharyngeal dysphagia as dominant and life-threatening symptom in dermatomyositis

• Published in: Vojnosanitetski pregled Vol. 66; no. 8; pp. 671 - 674
• Main Authors: Djakovic, Zorana, Vesic, Sonja, Tomovic, Maja, Vukovic, Jelena
• Format: Journal Article
• Language: English
• Published: Serbia Military Health Department, Ministry of Defance, Serbia 01.08.2009
• Subjects: deglutition disorders; Deglutition Disorders - diagnosis; Deglutition Disorders - etiology; dermatomyositis; Dermatomyositis - complications; Dermatomyositis - diagnosis; diagnosis; enteral nutrition; gastrostomy; Humans; Male; Middle Aged; myositis; treatment outcome
• ISSN: 0042-8450; 2406-0720
• DOI: 10.2298/vsp0908671d

Dysphagia can be a serious problem in patients with inflammatory myopathies. It may be associated with nutritional deficit, aspiration pneumonia, and poor prognosis. We presented a 60-year-old male, suffering from difficulty in swallowing, pain and weaknes in the proximal parts of his extremities, and skin manifestation. Laboratory findings showed increased creatine kinase and aldolase. Antinuclear antibodies to HEP-2 subtrate revealed titer of 1:40. Electromyoneurography demonstrated evidence of a proximal myopathy. A muscle biopsy revealed myositis. The baruim swallow test was remarkable for regurgitation, and nasal emerging of barium. Nuclear magnetic resonance images of cranium was normal. Tumor markers CEA, and Ca 19-9 were increased. A dose of 1 mg daily prednisolone was administered and percutaneous enteral feeding was performed. Two months later, the patient developed febrile state, aspiration pneumonia, and died due to respiratory failure. In cases of dermatomyositis with the serious dysphagia, percutaneous endoscopic gastrostomy should be performed as soon as possible. Overall survival rate is low, even with an adequate therapy administration. Inflammatory myopathies should be considered in any patient with oropharyngeal dysphagia.