The University of Toledo Translation Journal of Medical Sciences 
Gastrointestinal Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

Gastrointestinal Ulceration as a Manifestation of Severe 
Dermatomyositis - A Case Report 
Daniel O’Shea1*, Dhanushya Battepati1, Brandon Speedy1, David Farrow MD1, 
Megan Karrick DO1, Anas Renno MD1, Benjamin Hart MD1

1Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: Daniel.oshea@rockets.utoledo.edu

Published: 05 May 2023 

Introduction: A 32-year-old female with a history of adult-onset dermatomyositis presented to the 
emergency department with symptoms of fever and altered mental status. The patient was admitted for 
septic shock and multi-organismal pneumonia.   

Case Description: Ten months prior, the patient began having back aches, generalized myalgia, and a 
wide-spread rash. Three months later, a diagnosis of acute fulminant dermatomyositis was made with 
NXP-2, GAD-65 positivity on biopsy. Her course of illness required long-term use of systemic steroids, 
IVIG, methotrexate, mycophenolate mofetil, and rituximab alongside tracheostomy and PEGJ tube 
placement due to chronic respiratory and neuromuscular failure. With onset of melena and anemia, the 
patient underwent upper endoscopy. Ulceration was present throughout the esophagus, stomach and 
duodenum. While more profound ulceration was seen in the esophagus, two small ulcers in the 
duodenum containing visible, bleeding vessels required clipping. A repeat EGD under general anesthesia 
was completed for further evaluation and biopsy. Same-day colonoscopy was unremarkable. Esophageal 
and gastric biopsies revealed focal granulation tissue without evidence of malignancy, fungal elements, 
or viral inclusions. 

Discussion: Dermatomyositis is an inflammatory condition which largely affects skin and striated 
muscle, commonly presenting with proximal muscle weakness. Although the etiology is unclear, an 
autoimmune pathogenesis has been highly implicated. Pathogenic involvement of the gastrointestinal 
tract is rare. When it does occur, symptoms primarily include dysphagia, reflux, and gastroparesis. We 
present a case of severe dermatomyositis with esophageal, gastric, and duodenal ulceration. 

https://dx.doi.org/10.46570/utjms.vol11-2023-676 

https://dx.doi.org/10.46570/utjms.vol11-2023-676
mailto:Daniel.oshea@rockets.utoledo.edu