2017 Volume 34 Issue 3 Pages 315-319
A 74–year old man developed muscle weakness in the limbs and trunk along with skin rash. After 6 months, dysphagia appeared. Clinical examinations all supported a diagnosis of dermatomyositis and high–dose prednisolone (60mg/day) was therefore commenced. Symptoms were getting worse due to steroid myopathy. After 6 weeks, intravenous immunoglobulin (IVIg) (0.4g/kg/day×5days) was started. Although weakness in the limbs and concentrations of muscle enzymes improved in the relatively early stage, insufficient efficacy against severe dysphagia was seen after the first IVIg. Monthly IVIg was administered three times. Results of the saliva swallowing test improved from 0 time to 3 times. However, severe dysphagia remained and required percutaneous endoscopic gastrostomy. Videofluoroscopic examination of swallowing revealed stretch disorder at the esophageal orifice. Balloon dilatation to improve dysfunction of the cricopharyngeal sphincter was repeated almost everyday for 2 months. Severe dysphagia gradually improved, and the patient could eat jelly foods by 9 months after admission.
