title: Unilateral ptosis as an initial manifestation of D-penicillamine induced myasthenia gravis.
abstract: We describe 2 patients presenting with isolated unilateral ptosis without other signs of cranial or peripheral nerve involvement or sympathetic denervation. Both patients (one case of progressive systemic sclerosis and one of rheumatoid arthritis) were currently taking D-penicillamine. In these cases, the ptosis was reversed a few minutes after a Tensilon test, hallmark of myasthenia gravis. Antibodies to acetylcholine receptors were present. Myasthenia gravis should be suspected with ptosis without other cranial nerve involvement or miosis, even if the ptosis is unilateral. Thus, unilateral ptosis can be the first manifestation of a toxic side reaction to D-penicillamine.
authors.affiliation: Division of Immunology and Rheumatology, Stanford University Medical Center, CA.
authors.forename: J P
authors.initials: JP
authors.lastname: Raynauld
authors.forename: Y S
authors.initials: YS
authors.lastname: Lee
authors.forename: P
authors.initials: P
authors.lastname: Kornfeld
authors.forename: J F
authors.initials: JF
authors.lastname: Fries
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001763:Blepharoptosis / Q000209:etiology*; D005260:Female; D006801:Humans; D009157:Myasthenia Gravis / Q000139:chemically induced* / Q000150:complications*; D010396:Penicillamine / Q000009:adverse effects*; D012595:Scleroderma, Systemic / Q000188:drug therapy
chemical_list: D010396:Penicillamine