D-penicillamine and the ocular myasthenic syndrome

D-penicillamine is a potent drug used to treat rheumatoid arthritis, Wilson's disease and cystinuria. D-penicillamine has recently been found to cause myasthenia gravis in certain susceptible patients. We present a typical case of one patient who developed myasthenia while taking D-penicillamine. The withdrawal of D-penicillamine and the institution of short-term anticholinesterase therapy resulted in the resolution of this disease. The literature is reviewed and attention is focused on the point that all patients who developed myasthenia while undergoing D-penicillamine therapy had ocular symptoms.