Early-Onset Dysphagia Leading to the Diagnosis of Dermatomyositis and Polymyositis-Scleroderma Overlap: Report of Two Cases

Dysphagia can be the first presenting symptom of autoimmune myopathies, often leading to delayed diagnosis and treatment. We report two cases of severe dysphagia leading to the diagnosis of inflammatory myopathies. The first patient, a 26-year-old man, presented with progressive oropharyngeal and esophageal dysphagia and classic dermatomyositis skin manifestations. He responded well to intravenous methylprednisolone, IV immunoglobulin (IVIG), cyclophosphamide, and maintenance therapy with mycophenolate mofetil, achieving full recovery. The second patient, a 48-year-old woman, developed progressive dysphagia and weight loss and was diagnosed with polymyositis-scleroderma overlap syndrome. Treatment with corticosteroids, IVIG, rituximab, and mycophenolate led to significant improvement in swallowing and functional status. These cases highlight the importance of early recognition of autoimmune dysphagia and a multidisciplinary approach to management to prevent complications such as aspiration pneumonia, malnutrition, and long-term disability.