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[D-penicillamine-induced myasthenia gravis]
R A Frey1, F Keller, B A Michel
1Rheumaklinik, Universitätsspital, Zürich.
Schweizerische Medizinische Wochenschrift
|May 21, 1994
Summary
D-penicillamine can rarely cause myasthenia gravis in rheumatoid arthritis patients. This drug-induced condition improves after discontinuing D-penicillamine, with antibody levels normalizing.
Area of Science:
- Rheumatology
- Neurology
- Immunology
Background:
- D-penicillamine is a long-standing treatment for rheumatoid arthritis.
- Myasthenia gravis is a rare but serious complication associated with D-penicillamine therapy.
- The clinical presentation of drug-induced myasthenia gravis is similar to idiopathic forms.
Observation:
- A patient with rheumatoid arthritis developed severe myasthenia gravis while on D-penicillamine treatment.
- The patient required temporary treatment with acetylcholinesterase inhibitors.
- Acetylcholine receptor antibody titers were elevated in this patient.
Findings:
- Discontinuation of D-penicillamine led to the resolution of myasthenia gravis symptoms.
- Acetylcholine receptor antibodies disappeared 8 months after stopping the drug.
- Acetylcholinesterase inhibitor therapy was successfully withdrawn post-discontinuation.
Implications:
- This case highlights the importance of considering D-penicillamine-induced myasthenia gravis in rheumatoid arthritis patients.
- Reversible acetylcholine receptor antibodies suggest a potential pathogenetic link.
- Monitoring for neurological complications is crucial during D-penicillamine treatment.