|Year : 2015 | Volume
| Issue : 2 | Page : 148-149
Prolonged refractory dysphagia in polymyositis
Thomas Mathew, Mohan Muvvala, G R K Sarma, Raghunandan Nadig
Department of Neurology, St. John's Medical College, Bangalore, Karnataka, India
|Date of Web Publication||16-Mar-2015|
Department of Neurology, St. John's Medical College Hospital, Sarjapur Road, Bangalore - 560 034, Karnataka
Source of Support: None, Conflict of Interest: None
Herein, we report a patient with polymyositis (biopsy proved) with dysphagia that did not improve with conventional treatment. An upper gastrointestinal (GI) endoscopy showed esophageal stricture and a biopsy taken from the site revealed evidence of squamous cell carcinoma.
Keywords: Inflammatory myositis, polymyositis with dysphagia, upper GI endoscopy
|How to cite this article:|
Mathew T, Muvvala M, Sarma G, Nadig R. Prolonged refractory dysphagia in polymyositis. CHRISMED J Health Res 2015;2:148-9
|How to cite this URL:|
Mathew T, Muvvala M, Sarma G, Nadig R. Prolonged refractory dysphagia in polymyositis. CHRISMED J Health Res [serial online] 2015 [cited 2020 Mar 30];2:148-9. Available from: http://www.cjhr.org/text.asp?2015/2/2/148/153261
| Introduction|| |
Inflammatory myositis is often associated with dysphagia, which is due to involvement of the esophageal skeletal muscle.  Dysphagia can be a presenting symptom and often responds to medical treatment. 
| Case Report|| |
A 32-year-old lady was referred to our center for evaluation of proximal muscle weakness and dysphagia of three months duration. She was under the care of a physician who had empirically started her on steroids (prednisolone 60 mg/day), which did not improve her condition. When we evaluated she had significant proximal muscle weakness, which was symmetric, affecting lower limbs more than upper limbs (Medical Research Council grade 2/5 in lower limbs and 3/5 in the upper limbs). She had dysphagia more for solids than liquids. Her palatal movements and gag reflex were normal. Her ocular movements were full and had no facial weakness. The deep tendon reflexes were sluggish with bilateral flexor plantar response. There was no sensory impairment. There were no skin lesions suggestive of dermatomyositis.
Complete hemogram showed mild normocytic hypochromic anemia. Her creatine phosphokinase was 5600 U/L outside (before steroids) but decreased to 165 U/L after admitting at our hospital. Renal function tests, hepatic function tests and serum electrolytes were normal. Chest roentgenogram and sonological evaluation of abdomen and pelvis were unremarkable. The biopsy of left biceps was carried out which showed features of polymyositis. We increased the dose of steroids to 75 mg per day (prednisolone - 1.5 mg/kg/day) and added azathioprine. Her proximal power improved slightly but dysphagia never improved and indeed it worsened. An upper gastrointestinal (GI) endoscopy was asked for, and it showed multiple bleeding ulcers and stricture in the esophagus and the endoscope could not be passed beyond 28 centimeters. A biopsy was taken from the lesion, which showed features of moderately differentiated squamous cell carcinoma.
| Discussion|| |
The association of polmyositis and malignancy is rare, while dermatomyositis is commonly associated. Inflammatory myositis associated with esophageal malignancy has been scarcely reported in literature. Both adenocarcinoma and squamous cell carcinomas of esophagus have been linked with inflammatory myositis.  Esophageal carcinoma is relatively uncommon constituting 3% of all the malignancies, which may, in part account for the paucity of reports of esophageal carcinoma associated with inflammatory myositis.  This case underscores the importance of endoscopic evaluation in cases of polymyositis with dysphagia not responding to the usual line of management to exclude the possibility of esophageal malignancy.
| References|| |
Porkodi R, Shanmuganandan K, Parthiban M, Madhavan R, Rajendran P. Clinical spectrum of inflammatory myositis in South India-a ten year study. J Assoc Physicians India 2002;50:1255-8.
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 2007;82:441-7.
Sood A, Singh G, Midha V. Polymyositis and esophageal carcinoma. Am J Gastroenterol 1998;93:1011.
Karp SJ. Acute dermatomyositis associated with squamous carcinoma of the esophagus. J R Soc Med 1985;78:770-1.