The Journal of the Korean Rheumatism Association  2002;9(2):131-136

A case of myasthenia gravis in a patient with diffuse systemic sclerosis developed during D-penicillamine treatment.

Do Hyun PARK 1 ; Eun Young LEE ; Man Su AHN ; In KIM ; Son Mi CHUNG ; Jung Hyun SHIN ; Chang Keun LEE ; You Sook CHO ; Bin YOO ; Kwang Kuk KIM ; Hee Bom MOON

Affiliations

+expand

Keywords

Myasthenia gravis; Scleroderma; D-penicillamine

Country

Republic of Korea

Language

Korean

Abstract

D-penicillamine has been used to reduce skin thickening and prevent the development of significant organ involvement in the treatment of scleroderma. This drug has a number of serious adverse reactions including glomerulonephritis with nephrotic syndrome, aplastic anemia, thrombocytopenia, and myasthenia gravis. A 44-year-old woman was admitted for weakness of the extremity muscle during repeated use. Eight months before admission, she visited dermatology department of our hospital. She was diagnosed as having scleroderma. D-penicillamine was started for the treatment of skin lesions. Based on the fluctuation of proximal muscle weakness, high titer of acetylcholine receptor antibody and definite decremental response of Jolly test, she was diagnosed as myasthenia gravis. D-penicillamine was discontinued because of the suspicion of D-penicillamine induced myasthenia gravis. Muscle weakness improved after D-penicillamine was withdrawn. The development of reversible myasthenia gravis may be regarded as a part of general predisposition for autoimmune disease related to the D-penicillamine therapy.