Anti-MuSK- and anti-AChR-positive myasthenia gravis induced by d-penicillamine

MuSK autoantibodies in myasthenia gravis detected by cell based assay — A multinational study

“…In fact, MuSK antibodies have been shown to act, at least in part, by preventing the MuSK-LRP4 interaction (Huijbers et al, 2013;Koneczny et al, 2013), suggesting that they target epitopes close to or at the interacting regions. On the other hand, MuSK/AChR double positives have rarely been reported (Ohta et al, 2004;Poulas et al, 2012;Zouvelou et al, 2013). However, the MuSK CBA detected a higher than expected rate of AChR-MG patients with concomitant presence of MuSK antibodies.…”

Effect of Intravenous Low-Osmolality Iodinated Contrast Media on Patients with Myasthenia Gravis

“…are consultants to a law firm representing GE Healthcare regarding ongoing litigation M yasthenia gravis is a rare autoimmune condition, with a frequency in the United States of approximately seven to 10 per million individuals (1)(2)(3)(4). It is a T-cell-dependent process characterized by the formation of n-acetylcholine receptor and/or muscle-specific tyrosine kinase autoantibodies, resulting in disruption of neuromuscular transmission and a wide array of symptoms, including respiratory difficulty and extremity weakness to ocular and bulbar paralysis (5)(6)(7). The most serious complication of myasthenia gravis is "myasthenic crisis," which is characterized by lifethreatening paralysis and/or respiratory failure and occurs in up to 27% of affected individuals within 2 years of diagnosis (7,8).…”

Drug-Induced Disorders of the Nervous System

“…The antifungal agent voriconazole has been reported to transiently exacerbate ocular myasthenia through direct blocking of acetylcholine receptors. 180 These patients have acetylcholine receptor antibodies in the serum, and rarely muscle-specific kinase antibodies, suggesting that the drug initiates a humoral autoimmune response. 178,179 A syndrome indistinguishable from myasthenia gravis sometimes develop in patients receiving long-term d-penicillamine treatment.…”

“…177 Deterioration of myasthenia gravis and even myasthenic crisis may occur after botulinum toxin injections. 180 Other drugs reported to induce myasthenia include interferon-α, captopril, and thiopronine. 180 These patients have acetylcholine receptor antibodies in the serum, and rarely muscle-specific kinase antibodies, suggesting that the drug initiates a humoral autoimmune response.…”