D-penicillamine Induced Myasthenia Gravis in Wilson’s Disease: A Case Report

Abstract

Myasthenia gravis is a neuromuscular junction disorder characterised by fluctuating muscle weakness, improved by using anti-cholinesterase drugs. In addition to the autoimmune aetiology, various factors such as infections, surgery, and drugs are known to precipitate the condition. We report a case of a 15-year-old boy with D-penicillamine-induced myasthenia gravis who presented with facial diplegia, dysphagia, and drooling of saliva, 6 years after the initiation of treatment for Wilson’s disease. Therefore, clinicians should be more vigilant while prescribing patients with chelating drugs like D-penicillamine with regular monitoring of the new symptoms and keeping a very low threshold for the suspicion of myasthenia gravis.

D-Penicillamine-Induced Myasthenia Gravis—A Probable Complication of Wilson’s Disease Treatment—A Case Report and Systematic Review of the Literature

“…However, mostly in the course of RA treatment and only occasionally in WD [ 2 , 15 , 16 , 17 ]. From several retrospective analyses of WD patients treated with anti-copper agents (including DPA), it appears that cases of DPA-induced MG are incidental, with only seven cases in the medical literature and three cases in a Polish cohort of 1000 WD patients (data not published), indicating that it occurs less frequently that previously suggested [ 15 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

“…Based on data from the literature, DPA-induced MG occurs usually after 2–12 months but can be evident years after treatment initiation, especially in WD patients (6–96 months). The symptoms are generally ocular, with good response to pyridostigmine and clinical remission within one year after DPA treatment cessation: 70% of patients completely clinically recover, in contrast to idiopathic MG where 9.6 to 57.5% of patients will have remission during the first year [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. If MG symptoms persist, it seems that DPA treatment is only a trigger factor for MG.…”

“…Initially, we found 151 records during the PubMed search ( Figure 2 ). After the removal of duplicate and irrelevant articles, 7 records remained [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. One paper published in 1999 was not available [ 24 ] and this was also excluded from the analysis.…”

“…One paper published in 1999 was not available [ 24 ] and this was also excluded from the analysis. Finally, 6 papers describing 6 case reports were included ( Table 1 ) [ 20 , 21 , 22 , 23 , 25 , 26 ]. In an additional search of the Scopus, Embase, and Web of Science databases, we did not find any additional reports.…”