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DM with Pharyngeal Dysphagia — RACP Adult Medicine MCQ

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ModerateNeurologyDM with Pharyngeal DysphagiaRACP Adult Medicine

A 45-year-old woman presents with difficulty swallowing both solids and liquids simultaneously (oropharyngeal dysphagia), nasal regurgitation, and a nasal voice. She has proximal limb weakness and a heliotrope rash. CK is 5500 U/L. What is the most likely cause of dysphagia?

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Correct answer: A — Inflammatory myopathy (dermatomyositis)

Oropharyngeal dysphagia (difficulty initiating swallow, nasal regurgitation) with proximal weakness, heliotrope rash, and elevated CK is dermatomyositis affecting the pharyngeal striated muscles. Pharyngeal muscle involvement occurs in up to 30% of inflammatory myopathies. Treatment is high-dose corticosteroids plus steroid-sparing DMARD. Speech pathology assessment for aspiration risk is essential.

Reference: ACR/EULAR – 2017 – IIM Classification; eTG Rheumatology 2024