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 me
thotrexate, and hydroxychloroquine. The cutaneous component of her dis
ease flared dramatically months later, and progressed despite aggressi
ve therapy with the higher dosages of the same medications. Therapy wi
th intravenous immunoglobulin (IVIG) was initiated and the patient sto
pped 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.