Improvement in Tongue Pressure Precedes Improvement in Dysphagia in Dermatomyositis

Dysphagia is known to occur in patients with dermatomyositis. However, the sudden-onset dysphagia without other symptoms can make diagnosis and treatment challenging. Two patients who did not have a severe muscle weakness complained of the sudden inability to swallow solids and liquids. The muscle biopsy results showed the perifascicular atrophy, and the patients were diagnosed with dermatomyositis. Videofluoroscopy revealed an inadequate pharyngeal contraction and a decreased upper esophageal sphincter opening with silent aspiration. Both patients showed low tongue pressures. Patient 1 received intravenous and oral methylprednisolone, and patient 2 received intravenous immunoglobulin in addition to intravenous and oral methylprednisolone. Several months after the onset of the dysphagia, the swallowing function of both patients improved. The improvement in tongue pressure preceded an improvement in the subjective and objective measurements of dysphagia. In conclusion, tongue pressure may be useful for predicting early improvement in swallowing function.

Automated summary

Dysphagia is a known symptom of dermatomyositis, but it can be challenging to diagnose and treat sudden-onset dysphagia without other symptoms. Two patients without severe muscle weakness experienced sudden inability to swallow solids and liquids. Muscle biopsy results confirmed the diagnosis of dermatomyositis, and videofluoroscopy revealed pharyngeal contraction and upper esophageal sphincter opening issues. Both patients showed low tongue pressures. Treatment with methylprednisolone and immunoglobulin led to improvement in swallowing function, with tongue pressure improvement preceding subjective and objective measurements of dysphagia.