Myasthenia gravis as a complication of D-penicillamine therapy in rheumatoid arthritis

During the period 1971-79, 301 patients in the Voivodeship Integrated Hospital in Szczecin were treated with D-penicillamine (D-PCN). The complications observed included two cases of myasthenia gravis (MG), both in rheumatoid arthritis (RA) patients, one a 41-year-old man given the drug for 8 months, the other a 50-year-old woman treated in the same way for 4 months. In both patients, pneumomediastinography revealed enlargement of the thymus. Thymectomy followed by histological examination in both cases showed the existence of germinal centres and Hassall's bodies in the typical glandular texture. Follow-up examination 3 years later confirmed complete healing in the male patient and a marked improvement in the female patient.