Oropharynx Dysphagia In Dermatomyositis Patients
Keywords:
Disfagia orofaring, Dermatomiositis, Siklofosfamid, FEESAbstract
Introduction: Oropharyngeal dysphagia is one of the clinical manifestations of dermatomyositis, which can impact the patient's health and quality of life. Dermatomyositis is characterized by progressive muscle weakness and characteristic skin lesions. Oropharyngeal dysphagia is a significant complication, occurring in 10-73% of dermatomyositis patients. This case report describes the treatment of oropharyngeal dysphagia in a dermatomyositis patient with cyclophosphamide. Case report: A 38-year-old man with the main complaint of being unable to swallow saliva and solid food for 3 weeks, accompanied by weakness in the extremities and a reddish rash around the eyes. Laboratory examination showed an increase in serum CK. EMG showed demyelinating motor polyneuropathy. Skin biopsy was consistent with dermatomyositis. Initial FEES showed severe oropharyngeal dysphagia with penetrating aspiration. The patient was given high-dose methylprednisolone without significant improvement, followed by cyclophosphamide 1 gram for 7 cycles. Methods: A literature search was conducted in PubMed with the keywords “dysphagia” OR “swallow” AND “dermatomyositis” OR “polymyopathy” AND “cyclophosphamide”. Results: Cyclophosphamide administration showed clinical improvement after the second cycle. FEES evaluation after the sixth cycle showed improvement to mild oropharyngeal dysphagia. Two months post-therapy, patients reported significant improvements in swallowing and muscle strength. Conclusion: This case illustrates the manifestation of oropharyngeal dysphagia in dermatomyositis and significant improvement after administration of cyclophosphamide. FEES evaluation plays an important role in assessing the degree of dysphagia and response to therapy. Cyclophosphamide may be an option in cases of dermatomyositis with steroid-resistant dysphagia
Downloads
References
Malagelada JR, Bazzoli F, Boeckxstaens G. World gastroenterology organisation global guidelines: dysphagia-global guidelines and cascades. J Clin Gastroenterol 2015; 49(5):370-8.
Naik RD, Evers L, Vaezi MF. Advances in the diagnosis and treatment of GERD: new tricks for an old disease. Curr Treat Options Gastroenterol 2019; 17(1):1-17.
Dalakas MC. Inflammatory muscle diseases. N Engl J Med 2015; 372(18):1734-47.
Oh TH, Brumfield KA, Hoskin TL, Stolp KA, Murray JA, Bassford JR. Dysphagia in inflammatory myopathy: clinical characteristics, treatment strategies, and outcome in 62 patients. Mayo Clin Proc 2016; 91(6):710-8.
DeWane ME, Waldman R, Lu J. Dermatomyositis part I: clinical features and pathogenesis. Journal of the American Academy of Dermatology 2019; 82(2):267- 81.
Nilsson M, Eriksson O, Jönsson M. Dysphagia in inflammatory myopathies: a systematic review and meta-analysis. Neuromuscul Disord 2019; 29(8):590-601.
Pramudyo R, Hamijoyo L, Nugroho P. Clinical characteristics and outcomes of patients with dermatomyositis: a retrospective study from a tertiary referral hospital in Indonesia. Int J Rheum Dis 2020; 23(6):834-41.
Labeit B, Pawlitzki M, Ruck T, Muhle P, Claus I, Warnecke T, et al. The impact of dysphagia in myositis: a systematic review and meta-analysis. J Clin Med 2020; 9(7):2150-72.
Kamperman RG, Kooi AJ, Visser M, Aronica E, Raaphorst J. Pathophysiological mechanisms and treatment of dermatomyositis and immune mediated necrotizing myopathies: a focused review. Int J Mol. Sci 2022; 23(8):1-25.
Qudsiya Z, Waseem M. Dermatomyositis. StatPearls 2022. p. 1-13. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558917/#_NBK558917_pubdet_.Accessed Nov 16,2022
Mano T, Soyama S, Sugie K. Improvement in tongue pressure precedes improvement in dysphagia in dermatomyositis. Clin Pract 2022; 12(5):797-802.
Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med 1975; 292(7):344-7.
Prakoeswa FR, Suswardana, Danarti R. Juvenile dermatomiyositis: penegakan diagnosis. Biomedika 2014; 6(1):31-7.
Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, de Visser M, et al. European league against rheumatism/american college of rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis 2017; 76(12):1955-64.
Kalyan M, Kanitkar SA, Gaikwad AN, Kumar H. Dermatomyositis: a case report. Journal of Mahatma Gandhi Institute of Medical Sciences 2016; 21(1):53-5.
Targoff IN. Autoantibodies and their significance in myositis. Curr Rheumatol Rep 2008; 10(4):333-40.
Preston DC, Shapiro BE. Myopathies. In: Preston DC & Shapiro BE, eds. Electromyography and Neuromuscular Disorders. 3rd ed. London: Elsevier; 2013. p. 554-6.
Iqbal M, Akil A, Djamin R. Evaluasi proses menelan disfagia orofaring dengan fiberoptic endoscopic examination of swallowing (FEES). ORLI 2014; 44(2):137- 45.
Oddis CV, Aggarwal R. Treatment in myositis. Nat Rev Rheumatol 2018; 14(5):279-89.
Deakin CT, Campanilho-Marques R, Simou S, Moraitis E, Wedderburn LR, Pullenayegum E, et al. Efficacy and safety of cyclophosphamide treatment in severe juvenile dermatomyositis shown by marginal structural modeling. Arthritis Rheumatol 2018; 70(5):785-93.
Astrid Putri W. A., R.A. (2019) Hasil Profil Biopsi Pasien Penyakit Kulit Yang Tercatat Di Instalasi Teknologi Komunikasi Dan Informasi Rsud Dr Soetomo Surabaya Pada 1 Juli 2014 – 31 Juli 2019 Yang Dilakukan Pemeriksaan Patologi Anatomi. Skripsi. Surabaya: Universitas Airlangga.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
