Kava-kava is an herbal medication, most commonly used to treat anxiety. It is derived from the roots of the pepper plant, Piper methysticum. A 47-year-old white woman presented with a rash and proximal muscle weakness 2 weeks after ingestion of kava-kava. Her creatine kinase level was elevated at 8654 U/L, and an electromyogram showed a myopathic pattern. Skin biopsy and muscle biopsy samples showed changes consistent with dermatomyositis. The patient improved with prednisone and discontinuation of the kava-kava. No similar association between kava-kava ingestion and dermatomyositis has been reported previously.