Dermatomyositis: remission induced with combined oral cyclosporine and high-dose intravenous immune globulin.
Dermatomyositis is an uncommon idiopathic chronic inflammatory disorder. Oral corticosteroids are the treatment of choice. A few patients become resistant to steroids. We describe two patients who, after failure to respond to oral and high-dose intravenous corticosteroids, received a combination of oral cyclosporine and high-dose intravenous immune globulin, with apparent remission. The first patient was a 6-year-old girl with recurrent disease and vasculitis, despite prednisone therapy and normal muscle enzyme levels. The response was remarkable within 3 weeks of therapy. The second patient was a 30-year-old woman with progressive disease and secondary respiratory failure despite oral prednisone and methotrexate therapy. The response to treatment was optimal within 4 weeks. She received maintenance low-dose cyclosporine and a tapering dose of prednisone. The combination of high-dose immune globulin and cyclosporine can be useful and safe in the management of steroid-resistant dermatomyositis.
Saadeh
C
C
Department of Internal Medicine, Texas Tech University Health Sciences Center at Amarillo 79106, USA.
Bridges
W
W
Burwick
F
F
D000284:Administration, Oral; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D003402:Creatine Kinase / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage*; D003882:Dermatomyositis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000201:enzymology / Q000503:physiopathology; D012074:Remission Induction
D016756:Immunoglobulins, Intravenous; D016572:Cyclosporine; D003402:Creatine Kinase