BACKGROUND: Infection is a leading cause of mortality in idiopathic inflammatory myopathies (IIMs). This study aimed to develop a nomogram for predicting severe infection risk in IIM patients. METHODS: Patients with IIMs admitted to Zhongshan Hospital, Fudan University, from January 2015 to January 2022 were enrolled. They were randomly divided into derivation (70%) and validation (30%) sets. Univariate and multivariate Cox regression identified independent risk factors for severe infection, and the Akaike information criterion (AIC) was applied for model selection. A nomogram was constructed to predict severe infection risks at 6 months, 1 year, and 3 years. Predictive accuracy and discriminative ability were evaluated using the concordance index (C-index), calibration curves, and the area under the receiver operating characteristic curve (AUC). Decision curve analysis (DCA) assessed clinical utility. Kaplan-Meier (K-M) curves were used to analyze survival differences between high- and low-risk groups stratified by nomogram scores. RESULTS: Among 263 IIM patients, 81 experienced 106 severe infection events, with lower respiratory tract infections being the most common (47.2%). Independent risk factors included age at onset (HR 1.024, 95% CI 1.002-1.046, CONCLUSION: We have developed a new nomogram to predict severe infection risk in IIM patients at 6 months, 1 year, and 3 years. This model aids clinicians and patients in formulating treatment and follow-up strategies.