D-Penicillamine induced Myasthenia Gravis in a patient with Rheumatoid arthritis

Report of a case and Review of the literature

Abstract

A patient with rheumatoid arthritis (RA) developed myasthenia gravis (MG) after being treated with D-penicillamine (D-Pc) for 2 years. During the treatment with D-Pc, anti-nuclear antibody turned positive in the serological examination. Anti-DNA antibody and anti-acetylcholine receptor antibody were detected at the admission in our hospital and these titers tended to recede after D-Pc was ceased. Decreased number of peripheral blood B lymphocytes and the low ratio of helper and suppressor T lymphocytes (Th/Ts) (0.67) returned to normal following the discontinuance of D-Pc. Although D-Pc has been known to induce many immunological disorders, in Japan only ten cases with MG and one case with systemic lupus erythematosus (SLE) induced by D-Pc have been reported so far. We have reviewed the literature on these cases including our case.