Physical therapy is an evolving field and with the current push for direct access, physical therapists must have the skill set to recognize problems that fall outside their scope of care. Therefore, physical therapists must possess a background in recognizing the signs and symptoms of systemic infection and also be able to refer to the appropriate medical personnel. Dermatomyositis, is a condition that could be encountered by a physical therapist in a direct access situation, as it may mask as a musculoskeletal pathology in its early stages.1
CASE DISCRIPTION: Patient history and Systems Review
A 30 year old Caucasian female was admitted on 10/17/2013 to an inpatient rehabilitation facility. The patient began developing progressive extremity weakness in May of 2013, but delayed seeking medical attention secondary to lack of insurance. Prior to noticing extremity weakness, the patient developed facial rashes, abdominal, and joint pain. Patient first began noticing symptoms while ascending stairs, and felt a sense of heaviness. The patient was diagnosed with dermatmyositis on 9/3/13 by an outside hospital after undergoing a left deltoid biopsy, electromyography, and nerve conduction studies. Patient was then initially treated with IV solumedrol for five days. The patient then developed neck extensor weakness causing head droop, along with dysphagia and dyspnea when the administration of the drug was complete. She was transferred to another outside hospital and began two days of IV steroids, but the signs and symptoms persisted. The patient underwent an extensive workup for carcinoma, but was found to have dermatomyositis, confirmed by biopsy results from the Mayo Clinic. Diagnostic tests revealed the patient to have elevated creatine phosphokinase in the 4000 to 5000 range.
The patient had no family history of immune disease, and a past medical history consisting of mild anxiety, depression, hypertension, and thyroid disorder. Allergies included aldactazide, codeine, and hydrochlorothiazide. Current medications were methtrexate, amitriptyline, coumadin, eyedrops, lactulose, and lortab. The patient reports refraining from the use of alcohol and is a nonsmoker. Patient was previously employed as a housekeeper, while living with spouse and three children in a mobile home.
During the initial review of systems upon admittance, the patient did not complain of headaches or vision difficulties. Furthermore, denies chest pain, shortness of breath, and abdominal discomfort. Patient is able to eat and demonstrates ability to move the bowels, although she does have a foley catheter in place. The patient is cognitively intact as well.
On initial assessment, patient certainly has a marked debility secondary to dermatomyositis, which will take a month to a year to maximize improvement per the overseeing physician. Estimated length of stay is two to three weeks depending on condition. Patient was referred to...