Poster 16: Dysphagia Recovery After Initial Diagnosis of Polymyositis: A Case Report

Abstract

Setting: Rehabilitation hospital. Patient: A 40-year-old man admitted to an acute care hospital with a 1-month history of worsening extremity edema and weakness. Case Description: Workup, including blood chemistries, electromyography, and muscle biopsy, showed findings consistent with polymyositis. The hospital course was significant for severe dysphagia, necessitating gastrostomy-tube placement, and pneumonia. Steroid therapy was initiated. A videofluoroscopic swallow study (VFSS) at the acute care hospital revealed aspiration, and the patient was given nothing by mouth. Assessment/Results: On admission to the rehabilitation hospital, swallowing therapy was initiated including thermal-tactile stimulation, taste stimulation, base of tongue exercises, and laryngeal elevation exercises. Follow-up VFSS 12 days later and after initiation of steroid therapy revealed moderate to severe vallecular residue with solids secondary to reduced pharyngeal constrictor strength and reduced base of tongue retraction; however, there was no evidence of laryngeal penetration or aspiration. Discussion: The patient was advanced to a soft diet with thin liquids. A subsequent VFSS performed 11 days later revealed improved pharyngeal transit with no pharyngeal residue, aspiration, or penetration. The patient was advanced to a regular diet and swallowing therapy was discontinued. Conclusions: Dysphagia secondary to oropharyngeal involvement occurs in about a third of the patients and is a poor prognostic sign. This case report clearly shows the importance of early diagnosis and medical management to restore swallowing ability and improve overall quality of life. Dysphagia symptoms in patients with polymyositis may improve with appropriate medical management and swallowing rehabilitation.