Background: Dermatomyositis is a rare idiopathic inflammatory myopathy (IIM) characterized by skin lesions and systemic manifestations. Case Presentation: A 32-year-old Indonesian man who was consulted by the neurology department presented with upper and lower limbs weakness for three months. Based on the results of history taking, physical and supporting examination, the diagnosis of dermatomyositis was made. The initial therapy comprised azathioprine 50 mg (2-0-1), methylprednisolone 4 mg (5-4-4), and hydroxychloroquine 1x200 mg. Azathioprine was used instead of methotrexate due to elevated liver enzymes. However, after one month of treatment, azathioprine was found to be ineffective. As per the guidelines, if the patient does not respond after four weeks of initial treatment, the therapy should be changed to mycophenolic acid. At present, the patient has shown improvement in clinical symptoms and laboratory examination and is still being followed up. Conclusion: Dermatomyositis is a rare disease that is difficult to diagnose due to various differential diagnoses that must be ruled out. Prompt diagnosis and effective management of dermatomyositis are essential to improve patient outcomes. This case highlights the importance of considering alternative therapies for patients with dermatomyositis and elevated liver enzymes.

Dermatomyositis

Polimyositis

Muscle weakness