2021 Volume 25 Issue 3 Pages 238-244
Dermatomyositis is an autoimmune disease characterized by cutaneous symptoms and muscle weakness in the proximal muscles of the extremities. Dysphagia as a complication may also be one of the symptoms. Medication is usually successful, but there are still cases in which surgery is indicated. We experienced a case of severe dysphagia in dermatomyositis requiring a long period to resume oral intake. The patient underwent balloon dilatation training (balloon therapy), which is one of the feeding and swallowing rehabilitation treatments, and attained full oral intake after 3 years. We present the clinical course of the prolonged and refractory swallowing rehabilitation.
The patient was a male in his 60s with dermatomyositis (anti-OJ antibody positive). He had complained of pain in both shoulders, upper arms, and neck for 2 months prior to hospitalization. At the first visit, he suffered from skin lesions and muscle weakness in the trunk and proximal limbs, and was unable to keep the upper limbs elevated. Serum creatine kinase was elevated. In addition, he had dysphagia caused by obstruction of food passage and nasopharyngeal reflux.
At the beginning, he had persistent poor general condition and severe dysphagia, and was unable to undergo active swallowing rehabilitation. Significant aspiration, nasopharyngeal reflux, pharyngeal residue, and esophageal inlet obstruction were noted on videofluoroscopic (VF) examination of swallowing. He was treated with glucocorticoids and intravenous immunoglobulin, but his dysphagia remained impaired regardless of additional balloon therapy. After discharge from the hospital, only indirect swallowing training was continued. When reduction of the risk of aspiration was confirmed by VF, direct swallowing training was started and the balloon therapy was resumed. He was able to eat a soft food after about 2 years in total, and to drink freely after about 3 years, thus becoming completely independent with respect to oral intake.
Although glucocorticoids for dermatomyositis were maintained, he achieved complete oral intake by direct and indirect training and persistent balloon therapy. It is important to continue feeding and swallowing rehabilitation despite prolonged impaired oral intake.
