High-dose immunoglobulin therapy for a patient with dermatomyositis

A 46-year-old woman was admitted to our department complaining of dermal eruption and weakness of muscles. She was diagnosed as having dermatomyositis and was initially treated with prednisolone. Since her condition rapidly deteriorated, high-dose intravenous immunoglobulin (i.v.IG) therapy (0.4 g/kg/day i.v. for 5 days) was administered. Marked improvement in muscle strength was observed the following day after the first administration. She unfortunately died of pneumocystis carinii pneumonitis 2 weeks after the i.v.IG therapy. Autopsy revealed no inflammatory cells in the muscles, suggesting that i.v.IG therapy has an important clinical application for refractory dermatomyositis.