1979 Volume 46 Issue 5 Pages 377-380
Recently, D-penicillamine treatment has been provided to patients with rheumatoid arthritis frequently. This drug can definitely be considered as one of the most effective medications. However, this brings out various side-effects. This time, we experienced a case of myasthenia gravis induced by D-penicillamine treatment, and we hereby report on this specific case together with some discussion and literature studies. Several cases of myasthenia gravis associated with D-penicillamine treatment have been reported in European countries and in the United States, but we have not found any of the cases in Japan through our investigation.
The case : A 39-year-old woman with a 6-year history of rheumatoid arthritis had been treated in our clinic with a medication of 200 mg D-penicillamine per day. With the 20 weeks duration of the above dosage, the patient began to reveal symptoms such as dysarthria, dysphagia and ptosis. We immediately discontinued the medication of D-penicillamine. The patient was diagnosed as myasthenia gravis with a Tensilon test. We began to make a therapeutic approach with 10 mg of prednisolone and 120 mg of pyridostigmine per day, then the above symptoms were improved after four months.
The myasthenia gravis due to D-penicillamine treatment reported here may be quite rare, but should be considered as a warning indication to physicians that D-penicillamine should be administered with care and concern.
