Abstract
The efficacy of D-penicillamine in rheumatoid arthritis has now been clearly established, but the increasing use of this drug led many side effect. The common side effects are skin rashes, proteinuria, disturbance in taste and gastrointestinal upset.
We experienced two cases of rheumatoid arthritis with two major side effects of penicillamine, one episode of agranulocytosis and the other was myasthenia gravis. D-penicillamine was very effective in the both cases. The former was a 49-year-old woman who developed a precipitous fall in her granulocyte counts after about one month of penicillamine therapy at a daily dose of 300 mg. The latter was a 56-year-old man who developed a myasthenia like syndrome with diplopia and ptosis of left lid after about 5 months of penicillamine therapy at a daily dose of 200 mg.
Fortunately, the both patients were gradually improvement.
These side effects of penicillamine are very rare, and only two cases has been reparted in Japan, respectively. The physician must be familiar with these side effects and always pay attention to their appearrance during penicillamine therapy.
