J Korean Dysphagia Soc.  2024 Jan;14(1):71-79. 10.34160/jkds.23.021.

Dysphagia Caused by Dermatomyositis Misdiagnosed as Tumor Metastasis: A Case Report

• Lee R
• Lee CH
• Yun YJ
• Seo HG
• Park SH
• Oh BM

• KMID: 2559399
• DOI: http://doi.org/10.34160/jkds.23.021

Abstract

Dysphagia often occurs in cancer patients. The primary causes of dysphagia in cancer patients include new local dissemination of cancer cells or metastatic brain lesions, which needs to be accurately differentiated. Dermatomyositis is often associated with cancer and may manifest before or after the cancer diagnosis. Although early diagnosis and immunotherapy can improve dermatomyositis, its identification may be delayed in cancer patients due to complex comorbidities. We report a case of a 33-year-old woman with metastatic breast cancer who presented with dysphagia. The primary consideration was metastatic lesions. However, subsequent diagnosis revealed dermatomyositis. Symptoms, including facial swelling, dysarthria, and dysphagia, emerged 26 months after the cancer diagnosis. No new metastatic lesion was identified through imaging studies. A videofluoroscopic study (VFSS) revealed velopharyngeal insufficiency, reduced pharyngeal contraction, and excessive pharyngeal residue with silent aspiration. After a combination of further clinical, laboratory, and muscle biopsy findings, dermatomyositis was identified as the actual cause of dysphagia. The patient was treated with immunosuppressive and rehabilitative swallowing therapies, which improved her symptoms. This case underscores the critical importance of accurately identifying and promptly treating dysphagia in cancer patients. It particularly emphasizes the need to recognize dermatomyositis as a potential differential diagnosis in cancer patients presenting with dysphagia.

Keyword

Dermatomyositis; Dysphagia; Metastatic cancer; Videofluoroscopic study