Article Text

Download PDFPDF
Resistant dermatomyositis in a rural indigenous Maya woman
  1. Katia Cnop1,2,
  2. Boris Martinez1,3 and
  3. Kirsten E Austad1,4,5
  1. 1 Wuqu' Kawoq, Maya Health Alliance, Santiago, Guatemala
  2. 2 Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
  3. 3 Internal Medicine, Saint Peter’s University Hospital, Rutgers University, New Brunswick, New Jersey, USA
  4. 4 Internal Medicine Division of Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Kirsten E Austad, kirsten{at}


A 28-year-old indigenous Guatemalan woman presented with 7 months of progressive weakness and numerous dermatological findings. She initially sought care within the free government-run health system and was treated with oral steroids for presumed dermatomyositis. Her symptoms progressed, including severe dysphagia, hypophonia and weakness preventing sitting. She was lost to follow-up in the public system due to financial and cultural barriers. A non-governmental organisation tailored to the needs of Maya patients provided home intravenous pulse dose methylprednisolone in the absence of first-line biologicals. With longitudinal home-based care, she achieved symptom free recovery. The rising burden of chronic non-communicable diseases highlights shortcomings in health systems evident in this case, including lack of provider capacity, limited infrastructure to test for and treat rare diseases and poor continuity of care. We provide potential solutions to help care delivery in low-resource settings adapt to the demans of chronic disease control with particular attention to social determinants of health.

  • global health
  • rheumatology
  • dermatology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Patient consent for publication Obtained.

  • Contributors Caring for patient: all authors. Planning: all authors. Conception and design: KC and KEA. Acquisition of data: KC and BM. Interpretation: all authors. Drafting of manuscript: KC and KEA. Approved final manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.