(Kiosk 6) Discharge to Shelter: Juvenile Dermatomyositis in an Undocumented Immigrant (A Case Report)

Case Diagnosis: Juvenile dermatomyositis

Case Description or Program Description: Patient is a 9-year-old female with malnutrition, anemia, and juvenile dermatomyositis, who presented with a left thigh wound complicated by recurrent wound dehiscence and infections with abscesses.

Setting: Inpatient pediatric medicine unit

Assessment/Results: On admission she ambulated 40ft with supervision within her hospital room and used a personal wheelchair for community distances. By discharge she was able to ambulate 120ft with hand-held assistance, sufficient to navigate the hallways of her shelter. She was also educated on how to dress and bathe herself with her leg wound to prevent further infections, and was able to successfully participate at an age-appropriate level.

Discussion (relevance): Typically patients reside on the inpatient rehabilitation unit for 2 to 4 weeks, after which a determination is made for readiness for discharge home with home or outpatient services, or continue to rehabilitation for a longer period at a subacute rehabilitation facility or elsewhere. Given the knowledge that the latter was not an option for this patient, the rehabilitation team adjusted her goals accordingly, with intense inpatient therapies to further promote her functional capabilities during the remaining time she had on the pediatric medicine floor. In doing so, her mobility, ambulation and ability to independently perform tasks was maximized with the time she was allotted for her stay.

Conclusions: Introduction of early physiatry intervention has a significant impact on safe disposition. In this case, this integration benefited our 9-year-old patient who did not have the means to continue her recovery in a subacute rehabilitation facility, given the lack of insurance. With the close following of an inpatient rehabilitation team, her recovery program was tailored to her needs, which not only optimized her care during her remaining acute inpatient stay, but also successfully prepared her for a secure discharge to home (shelter) to family.