Effectiveness Of Ivig And Balloon Dilation Combination Therapy For Refractory Dysphagia In Anti-Tif1-Gamma Antibody-Positive Dermatomyositis

Dermatomyositis is an autoimmune inflammatory myopathy with characteristic cutaneous features. Dysphagia secondary to oropharyngeal and oesophageal involvement develops in a part of patients with dermatomyositis and may affect prognosis. Systemic immunosuppressive therapy is usually effective for dysphagia as well as cutaneous lesion and myositis. Here, we report a 78-year-old man with anti-TIF-1 gamma antibody-positive dermatomyositis that presented with an early gastric carcinoma and dysphagia resistant to oral prednisolone and tacrolimus therapy. Endoscopic examination demonstrated saliva retention in the piriform recess and saliva entering the larynx. A videofluoroscopy swallow study revealed a stricture of the oesophagus and accumulation of contrast media in the pharynx. A repetitive combination therapy of intravenous immunoglobulins and balloon dilatation was effective for dysphagia. In dermatomyositis patients with dysphagia, swallowing function should be evaluated at an early stage. Moreover, combination therapy with intravenous immunoglobulins and balloon dilation may be an optional treatment for refractory dysphagia.