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Polymyositis Associated With Severe Interstitial Lung Disease: Remission After Three Doses of IV Immunoglobulin

Catherine J. Bakewell, MD; Ganesh Raghu, MD
Author and Funding Information

From the Division of Rheumatology (Dr Bakewell) and the Division of Pulmonary and Critical Care Medicine (Dr Raghu), University of Washington Medical Center, Seattle, WA.

Correspondence to: Catherine J. Bakewell, MD, Division of Rheumatology, Box 356428, University of Washington Medical Center, Seattle, WA 98195; e-mail: bakewell@uw.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(2):441-443. doi:10.1378/chest.10-0360
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Interstitial lung disease associated with polymyositis/dermatomyositis (ILD-PM/DM) often confers a poor prognosis, and optimal treatment of this condition is not well defined. This report describes a 63-year-old man with severe ILD-PM/DM who presented with 5 months of progressive dyspnea and weakness. He had an initial carbon-monoxide-diffusing capacity of 35% predicted and a creatine kinase level of 2,112 U/L. After three monthly doses of immunoglobulin at 2 gm/kg IV, he has sustained clinical remission for > 2 years. IV immunoglobulin has not previously been studied as a first-line agent for rheumatologic diseases, and it is currently used as a salvage therapy. However, if IV immunoglobulin is capable of inducing sustained remission after brief use as a treatment, as demonstrated in this patient, especially in the setting of significant pulmonary involvement, then it merits further consideration for investigation as a first-line therapeutic agent.

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