Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1989 Dec;73(12):1015–1018. doi: 10.1136/bjo.73.12.1015

Ocular myasthenia gravis after D-penicillamine administration.

L J Katz 1, R L Lesser 1, J R Merikangas 1, J P Silverman 1
PMCID: PMC1041959  PMID: 2692700

Abstract

A 68-year-old black woman who was put on D-penicillamine therapy (250-500 mg per day, total dose 15 g) for rheumatoid arthritis developed ocular myasthenia gravis. Two weeks after she discontinued D-penicillamine her signs and symptoms cleared with no other treatment. Review of previous cases and possible immunological mechanisms are discussed.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aldrich M. S., Kim Y. I., Sanders D. B. Effects of D-penicillamine on neuromuscular transmission in rats. Muscle Nerve. 1979 May-Jun;2(3):180–185. doi: 10.1002/mus.880020305. [DOI] [PubMed] [Google Scholar]
  2. Argov Z., Mastaglia F. L. Drug therapy: Disorders of neuromuscular transmission caused by drugs. N Engl J Med. 1979 Aug 23;301(8):409–413. doi: 10.1056/NEJM197908233010805. [DOI] [PubMed] [Google Scholar]
  3. Argov Z., Mastaglia F. L. Drug therapy: Disorders of neuromuscular transmission caused by drugs. N Engl J Med. 1979 Aug 23;301(8):409–413. doi: 10.1056/NEJM197908233010805. [DOI] [PubMed] [Google Scholar]
  4. Atcheson S. G., Ward J. R. Ptosis and weakness after start of D-penicillamine therapy. Ann Intern Med. 1978 Dec;89(6):939–940. doi: 10.7326/0003-4819-89-6-939. [DOI] [PubMed] [Google Scholar]
  5. Benveniste M., Crouzet J., Homberg J. C., Lessana M., Camus J. P., Hewitt J. Pemphigus induits par la D-pénicillamine dans la polyarthrite rhumatoïde. Etude de cinq cas et recherche systématique des anticorps antisubstances intercellulaires de l'épiderme au cours du traitement. Nouv Presse Med. 1975 Dec 20;4(44):3125–3128. [PubMed] [Google Scholar]
  6. Bever C. T., Jr, Chang H. W., Penn A. S., Jaffe I. A., Bock E. Penicillamine-induced myasthenia gravis: effects of penicillamine on acetylcholine receptor. Neurology. 1982 Oct;32(10):1077–1082. doi: 10.1212/wnl.32.10.1077. [DOI] [PubMed] [Google Scholar]
  7. Bocanegra T., Espinoza L. R., Vasey F. B., Germain B. F. Myasthenia gravis and penicillamine therapy of rheumatoid arthritis. JAMA. 1980 Oct 17;244(16):1822–1823. [PubMed] [Google Scholar]
  8. Bucknall R. C., Dixon A St J., Glick E. N., Woodland J., Zutshi D. W. Myasthenia gravis associated with penicillamine treatment for rheumatoid arthritis. Br Med J. 1975 Mar 15;1(5958):600–602. doi: 10.1136/bmj.1.5958.600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. CRAWHALL J. C., SCOWEN E. F., WATTS R. W. Effect of penicillamine on cystinuria. Br Med J. 1963 Mar 2;1(5330):588–590. doi: 10.1136/bmj.1.5330.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Corrigan J. J., Jr, Kolba K. S., Gall E. P., Trombley J., Damiano M. L., Meredith K., Jeter M. Treatment of hemophilic arthritis with D-penicillamine: a preliminary report. Am J Hematol. 1985 Jul;19(3):255–264. doi: 10.1002/ajh.2830190307. [DOI] [PubMed] [Google Scholar]
  11. Epstein O., De Villiers D., Jain S., Potter B. J., Thomas H. C., Sherlock S. Reduction of immune complexes and immunoglobulins induced by D-penicillamine in primary biliary cirrhosis. N Engl J Med. 1979 Feb 8;300(6):274–278. doi: 10.1056/NEJM197902083000602. [DOI] [PubMed] [Google Scholar]
  12. Gordon R. A., Burnside J. W. D-Penicillamine-induced myasthenia gravis in rheumatoid arthritis. Ann Intern Med. 1977 Nov;87(5):578–579. doi: 10.7326/0003-4819-87-5-578. [DOI] [PubMed] [Google Scholar]
  13. Grahame-Smith D. G., Green A. R., Costain D. W. Mechanism of the antidepressant action of electroconvulsive therapy. Lancet. 1978 Feb 4;1(8058):254–257. doi: 10.1016/s0140-6736(78)90495-6. [DOI] [PubMed] [Google Scholar]
  14. Harpey J. P., Caille B., Moulias R., Goust J. M. Lupus-like syndrome induced by D-penicillamine in Wilson's disease. Lancet. 1971 Feb 6;1(7693):292–292. doi: 10.1016/s0140-6736(71)91022-1. [DOI] [PubMed] [Google Scholar]
  15. JAFFE I. A. Comparison of the effect of plasmapheresis and penicillamine on the level of circulating rheumatoid factor. Ann Rheum Dis. 1963 Mar;22:71–76. doi: 10.1136/ard.22.2.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Keesey J., Novom S. HLA antigens in pencillamine-induced myasthenia gravis. Neurology. 1979 Apr;29(4):528–529. doi: 10.1212/wnl.29.4.528-a. [DOI] [PubMed] [Google Scholar]
  17. LEE J. C., DUSHKIN M., EYRING E. J., ENGLEMAN E. P., HOPPER J., Jr RENAL LESIONS ASSOCIATED WITH GOLD THERAPY; LIGHT AND ELECTRON MICROSCOPIC STUDIES. Arthritis Rheum. 1965 Feb;8:1–13. doi: 10.1002/art.1780080102. [DOI] [PubMed] [Google Scholar]
  18. Masters C. L., Dawkins R. L., Zilko P. J., Simpson J. A., Leedman R. J. Penicillamine-associated myasthenia gravis, antiacetylcholine receptor and antistriational antibodies. Am J Med. 1977 Nov;63(5):689–694. doi: 10.1016/0002-9343(77)90153-x. [DOI] [PubMed] [Google Scholar]
  19. Merryman P., Jaffee I. A. Effect of penicillamine on the proliferative response of human lymphocytes. Proc Soc Exp Biol Med. 1978 Jan;157(1):155–158. doi: 10.3181/00379727-157-40011. [DOI] [PubMed] [Google Scholar]
  20. O'Keefe M., Morley K. D., Haining W. M., Smith A. Penicillamine-induced ocular myasthenia gravis. Am J Ophthalmol. 1985 Jan 15;99(1):66–67. doi: 10.1016/s0002-9394(14)75869-6. [DOI] [PubMed] [Google Scholar]
  21. Palferman T. G. Polymyalgia rheumatica and myasthenia gravis. J Rheumatol. 1981 Jan-Feb;8(1):169–171. [PubMed] [Google Scholar]
  22. Russell A. S., Lindstrom J. M. Penicillamine-induced myasthenia gravis associated with antibodies to acetylcholine receptor. Neurology. 1978 Aug;28(8):847–849. doi: 10.1212/wnl.28.8.847. [DOI] [PubMed] [Google Scholar]
  23. Schraeder P. L., Peters H. A., Dahl D. S. Polymyositis and penicillamine. Arch Neurol. 1972 Nov;27(5):456–457. doi: 10.1001/archneur.1972.00490170088013. [DOI] [PubMed] [Google Scholar]
  24. Sternlieb I., Bennett B., Scheinberg I. H. D-penicillamine induced Goodpasture's syndrome in Wilson's disease. Ann Intern Med. 1975 May;82(5):673–676. doi: 10.7326/0003-4819-82-5-673. [DOI] [PubMed] [Google Scholar]
  25. Sundstrom W. R., Schuna A. A. Penicillamine-induced myasthenia gravis. Arthritis Rheum. 1979 Feb;22(2):197–198. doi: 10.1002/art.1780220214. [DOI] [PubMed] [Google Scholar]
  26. WALSHE J. M. Penicillamine, a new oral therapy for Wilson's disease. Am J Med. 1956 Oct;21(4):487–495. doi: 10.1016/0002-9343(56)90066-3. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES