D-PENICILLAMINE INDUCED MYASTHENIA-GRAVIS

D-penicillamine has been used in the treatment of rheumatoid arthritis for years. As a rare complication of this treatment the occurrence of myasthenia gravis has been described, the clinical features of this c omplication being indistinguishable from that of idiopathic myasthenia gravis. Both D-penicillamine induced and idiopathic myasthenia gravis show elevated titers of acetylcholine receptor antibodies and respond to acetylcholinesterase inhibitor treatment. We report on a patient w ith rheumatoid arthritis who, under treatment with D-penicillamine, de veloped severe myasthenia gravis which required temporary acetylcholin esterase inhibitor therapy. 8 months after D-penicillamine was discont inued the acetylcholine receptor antibodies had disappeared and the ac etylcholinesterase inhibitors could be withdrawn. Clinical findings an d possible pathogenetic aspects of D-penicillamine induced myasthenia gravis are discussed.