Ocular myasthenia gravis after D-penicillamine administration.

Abstract

SUMMARY 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.

Drugs That Induce or Cause Deterioration of Myasthenia Gravis: An Update

“…D-penicillamine is known to cause a number of autoimmune diseases, including MG in about 1–7% of patients [ 28 , 29 ]. MG is often mild and predominantly ocular, and AChR Ab positive in about 80% of the cases [ 30 ], but a case of double positive (AChR and MuSK positive) has also been reported [ 31 ]. MG symptoms usually manifest 6–7 month with a range of one month to 8 years after starting penicillamine [ 30 ].…”

“…MG is often mild and predominantly ocular, and AChR Ab positive in about 80% of the cases [ 30 ], but a case of double positive (AChR and MuSK positive) has also been reported [ 31 ]. MG symptoms usually manifest 6–7 month with a range of one month to 8 years after starting penicillamine [ 30 ]. MG goes in complete remission in 70% of the cases 6–10 months after discontinuation of D-penicillamine [ 29 , 32 , 33 ].…”

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

“…About 20% of D-penicillamine-induced MG patients do not have detectable anti-AChR antibodies in their sera (Katz et al, 1989) and it is possible that, at least in some of these, MG is caused by antiMuSK antibodies. However, D-penicillamine has not previously been reported to cause the production of anti-MuSK antibodies.…”

Chlorpromazine induced ocular myasthenia gravis

“…Altered immunological reactivity with the population of B cell lymphocytes induced antibodies to acetylcholine receptors had been postulated in a previous study. 6 In this case, child had bilateral ptosis with no other signs of myasthenia gravis. Hence diagnosis of chlorpromazine induced ocular myasthenia was made.…”

“…5 Drugs causing ocular myasthenia includes antimicrobials like gentamicin, streptomycin, colistin, kanamycin and others like d-pencillamine, chloroquine, phenytoin, lithium etc. 6 The pathogenesis of drug induced myasthenia is not well understood. However probable increase in serum antibodies to acetylcholine receptor could be attributed for the pathogenesis.…”