CUTANEOUS ULCERS OF REFRACTORY ADULT DERMATOMYOSITIS RESPONSIVE TO INTRAVENOUS IMMUNOGLUBULIN

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.