729 - The Role of Inpatient Rehabilitation in Complicated Dermatomyositis

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

JK

Joseph N. Kastrenakes, n/a

Medical Student
NSU KPCOM
Clearwater, Florida, United States

Co-Author(s)

MA

Marlou Abril, n/a

Medical Student
Nova Southeastern University Dr. Kiran Patel College Osteopathic Medicine
West Miami, Florida, United States
AK

Azmeer Khamisani, MD

Resident Physician
University of Miami / Jackson Health Systems
Miami, Florida, United States
KB

Kaitlyn Brunworth, MD

Resident Physician
University of Miami / Jackson Health Systems
North Miami, Florida, United States
KD

Kevin L. Dalal, MD

Attending Physician
University of Miami / Jackson Health Systems
Miami, Florida, United States

Case Diagnosis: Dermatomyositis

Case Description: A 51-year-old male patient with a history of hypothyroidism and psoriatic arthritis presented for progressive muscle weakness, dysphagia, and weight loss over a period of two years. After which, his immunosuppressive psoriasis regimen was discontinued due to bowel intolerance, and the patient’s decline accelerated to the point of complete dependence for ADLs over the four months preceding admission. On physical exam, the patient demonstrated proximal muscle weakness, stooped posture, Gottron’s papules, holster sign, and heliotrope rash. Labs included a CPK over 3000 and elevated IgG and IgA levels. A clinical diagnosis of dermatomyositis was made. Treatment was initiated with prednisone, azathioprine, and IVIg. Seven days after admission, a severe choking incident led to swallow reevaluation and PEG tube placement. After a week of inpatient rehabilitation and optimization of nutrition, CPK levels decreased by over 300% and the patient regained independence in ADLs.

Discussions: While dermatomyositis is not a common diagnosis treated in inpatient rehabilitation, these patients have the potential to achieve great benefit from the multidisciplinary approach provided at these facilities. The functional limitations seen in dermatomyositis can frequently mirror those seen in more classic rehabilitation diagnoses such as stroke or spinal cord injury. For example, our patient suffered from dysphagia, atelectasis due to diaphragmatic dysfunction, focal weakness, impaired mobility, and decreased independence in ADLs as a result of his disease process. Moreover, dermatomyositis is a multisystem disease process, associated with malignancy, interstitial lung disease, cardiomyopathies, and other autoimmune conditions. Therefore, these patients can benefit from the expertise of a rehabilitation specialist to coordinate their multi-disciplinary, multi-specialty care.

Conclusions: Patients with multisystem disorders such as Dermatomyositis can greatly benefit from treatment by a rehab specialist. An interdisciplinary approach, including physical, occupational, and speech therapy as well as rheumatology and physiatry can optimize multiple etiologies of functional compromise.