Rehabilitation on a patient with tetraparesis due to dermatomyositis – case report

Introduction: Dermatomyositis (DM) is a connective tissue disease characterized by specific cutaneous findings, proximal muscle weakness and nonsuppurative skeletal muscle inflammation. DM often overlaps with other connective tissue diseases. Malignancies occur in up to 25% of cases. Materals and methods: Patient N.C., age 44, has been hospitalized in july 2015 for important physical asthenia, heliotrope rush, diffuse myalgias, symetrical proximal muscle weakness, dysphagia. Her laboratory tests showed: inflamatory syndrome, high muscle enzyme levels, highly positive Anti-SRP antibodies, positive lupic anticoagulant. The infectious and tumoral pathologies have been excluded, also any other autoimmune diseases, setting the dermatomyositis diagnosis. The efficient treatment was pulsed intravenous methylprednisolone and cyclophosphamide, followed by high-dose steroids with favorable evolution. In February 2016 she was admitted in our service presenting quadriparesis: weak proximal motor control, partially intermediate and good distal. Her laboratory testings were slightly modified (minimal increase of muscle enzymes levels by CK-MB increase). During the hospitalization the patient received vitamins, neurotrophics and physical therapy (electrostimulation to the muscles of the hip and shoulder, kinesiotherapy). She was evaluated according following scales: muscle strength (MRC), Functional Independence Measure (FIM), quality of life (QoL), (instrumental) activities of daily living (ADL, IADL). Results: Functional: the proximal muscle strength has increased with 1 point on MRC, FIM have risen with 4 points, QoL with 7 points: the trunk control and the transfers have improved, the patient can eat by herself and has moderately self-care. According ADL the patient has total dependence, yet. Conclusions: Patients with Anti-SRP antbodies highly positive can present with acute onset severe myopathy with significant muscle enzyme elevation and systemic features including dysphagia, cardiac involvement, that can be refractory to standard steroids treatments. Despite of the quasinormalized laboratory tests the muscle weakness is maintaing (corticosteroids induced miopathy?). Rehabilitation program improved the patient’s functionality and QoL.