Myasthenia gravis penicillamine-induced

Other drugs. Penicillamine causes some patients, especially those with rheumatoid arthritis, to form antibodies to the acetylcholine receptor and a syndrome indistinguishable from myasthenia gravis results. Spontaneous recovery occurs in about two-thirds of cases when penicillamine is withdrawn. Phenytoin may rarely induce or aggravate myasthenia gravis, or induce a myasthenic syndrome, possibly by depressing release of acetylcholine. Lithium may impair presynaptic neurotransmission by substituting for sodium ions in the nerve terminal. 

Xu et al. [5] described the effect of (z>)-penicillamine on the binding of several antiacetylcholine receptor monoclonal antibodies to the Torpedo acetylcholine receptor. Penicillamine is covalently incorporated into the acetylcholine receptor through SS exchange at the cysteine residues of the a-subunit, altering the antigenic structure of the receptor. This effect on the structure of the native receptor at the neuromuscular junction may be responsible for the establishment of the autoimmune response to the acetylcholine receptor in (i))-penicillamine-induced myasthenia gravis. Cysteine and penicillamine interact to form penicillamine-cysteine mixed disulfide complexes [6] ... 

Toxicity to the pulmonary system is uncommon, but severe dyspnea has been reported from penicillamine-induced bronchoalveolitis. Myasthenia gravis has been induced by long-term therapy with penicillamine. 

Drugs can cause a wide variety of other autoimmune reactions. One example is myasthenia gravis, which is characterized by muscle weakness and is mediated by antibodies against the acetylcholine receptor at the neuromuscular junction. It has been reported in association with penicillamine [66], gold salts [67], and procainamide [68]. Another form of drug-induced autoimmunity is polymyositis, which is an autoimmune disease... 

Nitrofurantion D-Penicillamine Peripheral neuritis Autoimmunity drug-induced SLE, myasthenia gravis, pemphigus, glomerulonephritis, Goodpasture s disease... 

Penicillamine-induced myasthenia gravis (SED-10, 415) was probably the cause of extremely prolonged apnea... 

Fried Ml, Protheroe DT. D-penicillamine induced myasthenia gravis. Its relevance for the anaesthetist. Br J Anaesth 1986 58(10) 1191-3. 

Raynauld JP, Lee YS, Komfeld P, Fries JF. Unilateral ptosis as an initial manifestation of D-penicillamine induced myasthenia gravis. J Rheumatol 1993 20(9) 1592-3. 

In addition, several autoimmune reactions to penicillamine can secondarily affect pulmonary function. PeniciUamine-induced polymyositis (56) or myasthenia gravis can cause respiratory failure, even requiring ventilatory support (57). The diagnosis and management of lupus-induced pleurisy have been reviewed (58). 

A 47-year-old woman developed concurrent pemphigus and myasthenia gravis (with ptosis and diplopia), apparently induced by penicillamine (500 mg/day for rheumatoid arthritis) (376). 

Drosos AA, Christou L, Galanopoulou V, Tzioufas AG, Tsiakou EK. D-penicillamine induced myasthenia gravis clinical, serological and genetic findings. Clin Exp Rheumatol 1993 11(4) 387-91. 

Liu GT, Bienfang DC. Penicillamine-induced ocular myasthenia gravis in rheumatoid arthritis. J Qin Neuroophthalmol 1990 10(3) 201-5. 

Garlepp MI, Dawkins RL, Christiansen FT. HLA antigens and acetylcholine receptor antibodies in penicillamine induced myasthenia gravis. BMJ (CUn Res Ed) 1983 286(6375) 1442-3. 

Seideman P, Ayesh R. Reduced sulphoxidation capacity in D-penicillamine induced myasthenia gravis. Clin Rheumatol 1994 13(3) 435-7. 

Torres CF, Griggs RC, Baum J, Penn AS. Penicillamine induced myasthenia gravis in progressive sclerosis. Arthritis Rheum 1980 23 505-508. 

Vincent A, Newsom-Davis J. Acetylcholine receptor antibody characteristic in myasthenia gravis. Patients with penicillamine-induced myasthenia or idiopathic myasthenia of recent onset. Clin Exp Immunol 1982 49 266-272. 

Bever CT, Chang HW, Penn AS, Jaffe lA, Bock E. Penicillamine induced myasthenia gravis. Effects of penicillamine on acetylcholine receptor. Neurology 1982 32 1077-1082. 

D-Penicillamine. A drug that is able to induce a variety of autoantibodies and autoimmune diseases (e.g. myasthenia gravis, polymyositis). Disease usually remits within one year after the medication is stopped. 

Myasthenia gravis, acquired. The most well understood autoimmune disease. Muscle weakness usually affecting ocular and oropharyngeal muscles due to an autoimmune attack against the neuromuscular junction (e.g. nicotinic acetylcholine receptor). May be idiopathic, paraneoplastic (thymic tumour), or drug-induced (D -penicillamine). 

Russell AS, Linstrom JM. Penicillamine-induced myasthenia gravis associated with antibodies to acetylcholine receptor. Neurology (1978) 28, 847-9. 

The first case of anti-muscle-specific kinase-antibody-mediated myasthenia gravis induced by D-penicillamine was reported [75 ]. The female patient developed symptoms following D-penicillamine treatment for scleroderma. Upon withdrawal of the D-penicillamine, the patient gradually became asymptomatic for myasthenia gravis. 

Poulas K, Koutsouraki E, Kordas G, Kokla A, Tzartos SJ. Anti-MuSK- and anti-AChR-positive myasthenia gravis induced by d-penicillamine. J Neuroimmunol September 15,2012 250(l-2) 94r-8. 

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