Maria Lee, BS
Medical Student
SUNY Downstate Health Sciences University
BROOKLYN, New York, United States
Muhammad S. Rizwan, DO
Fellow Physician
Burke Rehabilitation Hospital
Piscataway, New Jersey, United States
Lawrence Andrew L. Chan, D.O.
Clinical Assistant Professor
SUNY Downstate Health Sciences University
Brooklyn, New York, United States
64-year-old female with Systemic Sclerosis with dysphagia and odynophagia secondary to complications of systemic sclerosis.
Case Description:
A 64-year-old female with a history of Systemic Sclerosis presented with painful and difficult swallowing. Laboratory findings showed elevated potassium and she was admitted for odynophagia and dysphagia secondary to her Systemic Sclerosis. Video swallow studies showed increased secretions. PM&R evaluated the patient and she was admitted to the acute rehabilitation unit for dysphagia management.
The patient completed a course of acute rehabilitation and made some improvements in her swallowing function. However, after discharge, her swallowing issues continued to decline and she returned to acute inpatient rehabilitation for further management. She completed a second course of rehabilitative services with moderate improvement in her dysphagia before being discharged.
Discussions: The management of dysphagia in scleroderma poses significant challenges due to the progressive nature of the disease and its impact on various systems, particularly the gastrointestinal tract. Scleroderma-associated dysphagia can lead to nutritional deficiencies, aspiration risk, and decreased quality of life. While systemic sclerosis presents with many clinical symptoms, dysphagia is often not the primary presenting feature. Despite these challenges, our patient's successful rehabilitation highlights the importance of a comprehensive approach to managing scleroderma-associated swallowing deficits.
Conclusions:
This case highlights the need for aggressive management of swallowing difficulties in a patient with Systemic Sclerosis and multiple comorbidities. Our patient required multiple acute inpatient rehabilitation admissions for treatment of this condition. The interdisciplinary approach involving ENT, GI, and rehabilitation services was crucial in achieving successful outcomes. By integrating interventions such as dietary modifications, swallowing therapy, esophageal dilation procedures, and addressing underlying systemic issues contributing to dysphagia, the team was able to optimize the patient's swallowing function and overall well-being.
