The Passion Dream Book travels from the Italian Renaissance, when a girl spends her days spying on a famous young artist and experiences the divided love of wanting the artist and wanting to be the artist. Progressing to the early years of the 20th century, the novel follows the experiences of two artists, Romy March, a descendent of the Renaissance girl, and Augustine Marks.

Otto's novel is an imaginative mix of fact and fiction, history and story about the two enduring, occasionally conflicting passions of love and work. As Romy March and Augustine Marks migrate from place to place, separately and together, their love is their home and their home is each other.

The outsider lives they lead provide them with various living situations, including silent-era Hollywood, the Harlem Renaissance, Paris in the late 1920s and back to America. The novel touches on the migratory habits of artist colonies (and why they don't last), on race (since Romy and Augustine are of different races) and how one lives when tradition does not hold.