Anti-MuSK- and anti-AChR-positive myasthenia gravis induced by d-penicillamine.
Τίτλος | Anti-MuSK- and anti-AChR-positive myasthenia gravis induced by d-penicillamine. |
Publication Type | Journal Article |
Year of Publication | 2012 |
Authors | Poulas, K., Koutsouraki E., Kordas G., Kokla A., & Tzartos S. J. |
Journal | J Neuroimmunol |
Volume | 250 |
Issue | 1-2 |
Pagination | 94-8 |
Date Published | 2012 Sep 15 |
ISSN | 1872-8421 |
Λέξεις κλειδιά | Aged, Antirheumatic Agents, Autoantibodies, Autoantigens, Female, Humans, Myasthenia Gravis, Penicillamine, Receptor Protein-Tyrosine Kinases, Receptors, Cholinergic, Scleroderma, Systemic |
Abstract | BACKGROUND: Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction usually caused by antibodies to the nicotinic acetylcholine receptor (AChR) and occasionally to muscle-specific kinase (MuSK). D-penicillamine is a therapeutic agent for several diseases, but can also induce a number of immune-mediated disorders, including MG, as a side-effect. In most patients with D-penicillamine-induced MG, anti-AChR antibodies are detected, but the presence of anti-MuSK antibodies has not been reported previously.CASE: The case reported was a female patient who presented with myasthenic symptoms after D-penicillamine administration for scleroderma.RESULTS: Both anti-AChR and anti-MuSK antibodies were identified in the patient's serum. The anti-MuSK antibodies were of the IgG4 subclass, as in idiopathic MG. Both types of antibody gradually disappeared after discontinuation of D-penicillamine. A significant improvement in symptoms was observed and the patient gradually became free of MG symptoms, without requiring any treatment for MG. Another four double-positive (anti-AChR and anti-MuSK antibodies) patients were identified during a retrospective study, but none had been treated with D-penicillamine.CONCLUSION: D-penicillamine can cause anti-AChR and anti-MuSK antibody-positive MG, a rare phenomenon which is reversed after discontinuation of D-penicillamine treatment. |
DOI | 10.1016/j.jneuroim.2012.05.011 |
Alternate Journal | J. Neuroimmunol. |
PubMed ID | 22683336 |