Dysphagia as the Presenting Symptom for Inclusion Body Myositis

Abstract

Dysphagia can be one of the manifestations of inflammatory myopathies (IMs). In some patients, it can be one of the presenting symptoms or the only symptom. We present a patient with dysphagia and progressive muscle weakness who was eventually diagnosed with inclusion body myositis (IBM). Treatment with oral steroid provided no major improvement in symptoms and thus was eventually stopped. Dysphagia in IMs is associated with complications and poor prognosis. A multidisciplinary approach is needed in its diagnosis and management as this report exemplifies.

Keywords: dysphagia and inflammatory myopathy; gastroenterology.

Figure 1.

Modified barium swallow showed a narrowing at the cricopharyngeal area (as indicated by the yellow arrow on the image).

Figure 2.

Esophagogastroduodenoscopy image post-dilation showing mild bleeding and mucosal injury (indicated by yellow arrows), at the level of the upper esophageal sphincter. Mild bleeding and mild mucosal injury are expected post-dilation.

Figure 3.

This skeletal muscle (left bicep) shows infiltration by mononuclear inflammatory cells. Scattered muscle necrosis, as noted in between the yellow arrows, is identified by pale, pink muscle fibers. Muscle fibers vary in diameters (5-100 µm), compatible with scattered muscle atrophy. Finally, patchy expansion of the endomysium is present due to the inflammatory infiltrates (4× magnification).

Figure 4.

This skeletal muscle (left bicep) shows infiltration by mononuclear inflammatory cells, consisting mostly of lymphocytes and occasional histiocytes (indicated by yellow arrow). Muscle fiber necrosis is noted by a pink, pale appearance, compared with surrounding fiber. No rimmed vacuoles, ringed fibers, or inclusion bodies are identified (40× magnification).