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• W2921285831 abstract "Introduction Dermatomyositis (DM) often presents with muscle weakness and skin manifestations. A review of the literature found severe disease in the elderly can be associated with edema and dysphagia. Early diagnosis of patients with severe disease is necessary for aggressive treatment and to minimize morbidity and mortality. Case Description A 65-year-old Caucasian female with PMH of NAFLD presented with weakness, edema and dysphagia. Her initial symptom was a pruritic rash on her scalp treated with prednisone three months prior. She subsequently developed weakness and edema in her arms bilaterally and dysphagia. She denied recent travel, medication changes, using herbal/over the counter products, fever, or shortness of breath. The patient worked in a home improvement store and was in contact with fertilizers. Notable laboratory studies showed CK 2372 U/L, AST/ALT 194/86 IU/L, Total Bilirubin 1.3 g/dL, Direct Bilirubin 0.2 g/dL, C3 170 mg/dL, C4 77 mg/dL, ESR 60 mm/hr, ANA +1:40 U, ASMA +1:20 U. Hepatitis panel, Scl 70, and AMA were negative. EGD found esophagitis and gastritis. She failed several speech and swallow studies and a percutaneous gastrostomy (PEG) was placed. She was started on prednisone 60 mg po QD. With little clinical improvement and rising CK and LFTs, the patient was transferred to a tertiary medical center. At the tertiary center a left deltoid biopsy showed skeletal muscle with solitary necrotic muscle fibers and confluent areas of muscle fiber necrosis, rare regenerating muscle fibers and perimysial lymphocytic inflammation consistent with DM. She was started on IV solumedrol 500 mg QD with taper while inpatient. Cellcept 500 mg via PEG was given and increased to 2000 mg QD outpatient. At discharge the patient's LFTs and CPK resolved and her edema and muscle weakness improved. Outpatient, she was transitioned to prednisone 20 mg po QD. Due to financial issues, cellcept was switched to methotrexate 15 mg po weekly. The patient's weakness, edema and swallowing ability improved and her PEG was removed 6 months later.Discussion The presence of dysphagia and PEG placement in elderly patients with DM infers higher morbidity and mortality, mainly related to respiratory complications. Therefore it is critical to consider DM with elderly patients who present with muscle weakness, edema and dysphagia. Early diagnosis can lead to more aggressive treatment, preventing PEG placement and improving morbidity and mortality in these patients." @default.
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• W2921285831 date "2018-10-01" @default.
• W2921285831 modified "2023-09-27" @default.
• W2921285831 title "A Case Report on Dysphagia and Edema in an Elderly Patient: Warning Signs for Severe Dermatomyositis" @default.
• W2921285831 doi "https://doi.org/10.14309/00000434-201810001-01818" @default.
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