Atypical Presentation of Dysphagia in a Patient Diagnosed Later With Dermatomyositis: A Case Report

Dysphagia has been reported in 10%-73% of patients with dermatomyositis. We present the case of a 58-year-old female patient who presented to the emergency department of Peterborough City Hospital with acute-onset difficulty in swallowing. Physical examination demonstrates proximal muscle weakness of the upper limbs and symmetrical skin rash over the face, chest, and thighs. Both clinical and laboratory findings pointed towards the diagnosis dermatomyositis. Oesophagogastroduodenoscopy identified no significant abnormality reducing the possibility of dysphagia due to an intrusive lesion, such as an abscess or a malignancy. MRI scan of the lower limbs revealed evidence of proximal myositis. CT neck, chest, abdomen and pelvis exclude any associated malignancy. The patient was treated initially with intravenous pulses of methylprednisolone for three days, and then switched to oral prednisolone and cyclophosphamide cycles and was considered for intravenous immunoglobulins as her symptoms had not completely resolved.