1335 - Healing Beyond The Surface: Non-Healing Ulcers and Dysphagia In Dermatomyositis

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SC

Stephen Chien, BA

Medical Student
Drexel University College of Medicine
Reading, Pennsylvania, United States

Co-Author(s)

PG

Pearl Galido, DO

Resident Physician
Northwell
Manhasset, New York, United States
EP

Evan Purvis, MD

Resident Physician
Northwell Health
Mineola, New York, United States
RA

Rawa Araim, MD

Attending Physican at Glen Cove Hospital rehabilitation unit
Northwell
GLEN COVE, New York, United States

Submitter(s)

SC

Stephen J. Chien, BA

Drexel University College of Medicine
Reading, Pennsylvania, United States

Case Diagnosis: Dermatomyositis

Case Description: A 35-year-old female with a history of hypothyroidism and dermatomyositis presented to an acute hospital after one month of increasing proximal limb weakness resulting in difficulty with ambulation, dysphagia, and non-healing cutaneous ulcers of the neck, shoulders, and forearms. At the acute hospital, the patient was initially placed on a pureed diet. Despite treatment for dermatomyositis with corticosteroids, intravenous immunoglobulin (IVIG), and rituximab, her dysphagia progressed. Her diet changed to nothing by mouth (NPO), ultimately requiring a percutaneous endoscopic gastrotomy (PEG) tube placement for nutrition. During acute rehabilitation, the patient continued on PEG tube feedings and started expiratory muscle strength testing (EMST). She graduated to a pureed diet and eventually soft-and-bite-sized diet. Special skin precautions including limited sun exposure were implemented for integument protection. The patient is expected to continue speech and language therapy outpatient and continue functional gains.

Discussions:
Dysphagia affects 10-73% of patients with dermatomyositis. Advanced disease may present with aspiration risk, requiring nutrition via PEG. EMST can be beneficial in patients with dysphagia and reduced airway protection by strengthening muscles involved in swallowing and coughing. Nutrition is especially important in cases with non-healing cutaneous ulcers, which impact 3-19% of patients with dermatomyositis. Ulcerations can be painful, cause further complications like gangrene or osteomyelitis, and are associated with increased resistance to immunosuppressive treatment. Inpatient acute rehab provides a unique environment where patients with functional deficits that impact wound healing have an opportunity to advance their diets to support their nutritional needs and improve quality of life.

Conclusions:
Inpatient rehabilitation for the treatment of dermatomyositis and its complications should include speech-language pathology and nutritional support in the setting of dysphagia and non-healing cutaneous ulcers, as well as strengthening.