D-penicillamine-induced myasthenia gravis: diagnosis obscured by coexisting chronic obstructive pulmonary disease

Am J Med Sci. 1995 Apr;309(4):191-3. doi: 10.1097/00000441-199504000-00001.


D-penicillamine, a drug used to treat rheumatoid arthritis, Wilson's disease, and cystinuria, can cause myasthenia gravis. Fortunately, the myasthenia typically resolves after discontinuation of the drug. The diagnosis may be missed if weakness is blamed on a patient's underlying disease(s), in particular, rheumatoid arthritis. Reported here are the cases of two patients with chronic obstructive lung disease who were taking D-penicillamine for rheumatoid arthritis, then experienced increasing respiratory failure. At first, their problem seemed to stem from chronic lung disease, but further evaluation revealed the cause of the hypoventilation to be D-penicillamine-induced myasthenia gravis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy
  • Female
  • Humans
  • Hypoventilation / etiology
  • Lung Diseases, Obstructive / complications*
  • Male
  • Middle Aged
  • Myasthenia Gravis / chemically induced*
  • Myasthenia Gravis / complications
  • Myasthenia Gravis / diagnosis
  • Penicillamine / adverse effects*
  • Respiratory Insufficiency / etiology


  • Penicillamine