Bar None: A Rare Cause of Oropharyngeal Dysphagia

Excerpt

A 70-year-old obese male previously diagnosed with inclusion body myositis (IBM) on the basis of a muscle biopsy a year prior to presentation to the gastroenterology clinic with complaints of progressive swallowing difficulties. He described the sensation of food sticking below his Adam’s apple with occasional regurgitation. He also stated that he occasionally experienced choking when swallowing. He noticed that he had to swallow repeatedly to help clear solid food. Furthermore, he complained of drooping of his eyelids. Otherwise he denied any changes in voice, difficulty with speech, trouble with language, neck pain or swelling, or cough. He was a former smoker and used to drink 4–5 beers per week, but quit these one year previously. He had had some baseline difficulty breathing with walking for some time and had experienced heartburn, controlled by taking oral pantoprazole 20 mg twice daily. He had previously undergone a partial uvulectomy about 6–7 years prior for obstructive sleep apnea and more recently had a muscle biopsy that established the diagnosis of IBM. The biopsy findings shown in Figs. 1 and 2 reveal, on H&E staining features of an inflammatory myositis (Fig. 1a): additional special stains (Figs. 1b, 2a, b) demonstrate features characteristic of IBM.

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