Cutaneous ulcers of refractory adult dermatomyositis responsive to intravenous immunoglobulin.

We report the case of a woman from the Bahamas who presented with many of the classic manifestations of dermatomyositis. She responded well to initial therapy, which included oral corticosteroids, low-dosage methotrexate, and hydroxychloroquine. The cutaneous component of her disease flared dramatically months later, and progressed despite aggressive therapy with the higher dosages of the same medications. Therapy with intravenous immunoglobulin (IVIG) was initiated and the patient stopped forming new cutaneous ulcers within 1 to 2 weeks. Theories about the mechanism of action of IVIG, and practical guidelines for its use in treating patients with dermatomyositis, are briefly reviewed.