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Case Reports
. 2022 Jul 1;60(251):644-647.
doi: 10.31729/jnma.7607.

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

Lekhjung Thapa  1 , Monika Thapa  1 , Suman Bhattarai  1 , Abhishek Man Shrestha  1 , Nooma Sharma  1 , Nilshan Rai  2 , Merina Pokharel  1 , Raju Paudel  1
Affiliations
Case Reports

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

Lekhjung Thapa et al. JNMA J Nepal Med Assoc. .

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.

Keywords: d-penicillamine; myasthenia gravis; pyridostigmine; Wilson's disease.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. MRI (T2WI) of the brain showing abnormal hyperintensity in bilateral basal ganglia.
Figure 2
Figure 2. Facial weakness with incomplete closure of mouth and bilateral eyes.
Figure 3
Figure 3. RNS of the left facial nerve (using 10 stimulation trains and 2 Hz frequency) showing >10% decremental response. Stimulation site: Left facial nerve. Recording site: Left orbicularis oculi.
Figure 4
Figure 4. Improvement in facial weakness and complete closure of eyes at 2 months follow-up.
See this image and copyright information in PMC

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