Mini Case Series: Dysphagia and Complications of Dermatomyositis During Inpatient Rehabilitation.
American Journal of Physical Medicine & Rehabilitation
Case Diagnosis: Dermatomyositis
Case Description: Case 1 is a 59-year-old male with past medical history (PMH) of diabetes mellitus. Case 2 is a 69-year-old male with PMH of prostate cancer and stroke. Both patients initially presented with proximal muscle weakness and rashes on their face and arms. The laboratory results for each patient showed elevated inflammatory markers including elevated creatine phosphokinase and positive antinuclear antibody. Biopsy confirmed both diagnoses. Case 1’s biopsy revealed necrotizing myopathy, while Case 2’s biopsy showed myositits. Rheumatology treated with prolonged steroids. Both patients developed dysphagia during hospitalization requiring percutaneous endoscopic gastrostomy (PEG) tube placement. Both were admitted to Inpatient Rehabilitation (IPR). Case 1 was discharged home after 17 days with a Functional Independence Measurement (FIM) of 75. Four months post-IPR patient lost 60lbs and was diagnosed with stage IVB epiglottis squamous cell carcinoma. Case 2 was discharged home after 18 days; FIM 88. Work-up pending for questionable malignant lung nodule.
Discussions: Dysphagia greatly impacts patients’ nutrition status, healthcare costs and quality of life. There should be a high suspicion of underlying cancer in dermatomyositis patients with incidence of 5-8%. Patient’s with dermatomyositis require a specialized rehabilitation plan to promote gains in strength and aerobic endurance while avoiding isolated eccentric muscle contractions.
Conclusions: Nutrition is critically important in dermatomyositis patient’s as protein is needed to regain muscle. Close monitoring of weight and renal function should be regularly performed. PEG site care and dysphagia can be addressed in IPR. Patients receiving adequate nutrition who continue to lose weight should be investigated for underlying malignancy. For best outcomes patient’s require clear communication between an interdisciplinary team.
Sankovic R, Reyes A, McCallum J, Mafiah M, Roskos PT. Mini case series: dysphagia and complications of dermatomyositis during inpatient rehabilitation. Am J Phys Med Rehab. 2021;100(4 suppl.):a86.