Masters C L, Dawkins R L, Zilko P J, Simpson J A, Leedman R J
Am J Med. 1977 Nov;63(5):689-94. doi: 10.1016/0002-9343(77)90153-x.
Myasthenia gravis with thymic hyperplasia developed in a patient with Wilson's disease after eight years of penicillamine treatment. Four months prior to the onset of myasthenia, penicillin hypersensitivity was observed. Immunofluorescence on the excised thymus revealed immunoglobulin and complement deposition, but the myasthenia persisted after thymectomy and continuation of penicillamine therapy. Increased antiacetylcholine receptor antibody was demonstrable throughout. This patient subsequently became pregnant, enabling studies to be performed on the transplacental transfer of the immunoglobulin G (IgG) class antiacetylcholine receptor antibody. Eleven cases of rheumatoid arthritis with penicillamine-associated antistriational antibodies have also been observed; in three of these cases there was evidence of myasthenia gravis. These observations extend earlier reports of the association of penicillamine with myasthenia gravis and suggest that antistriational antibody, antiacetylcholine receptor antibody and thymic hyperplasia may be independent effects of penicillamine therapy.
一名患有威尔逊病的患者在接受青霉胺治疗八年后出现了伴有胸腺增生的重症肌无力。在重症肌无力发作前四个月，观察到青霉素过敏。对切除的胸腺进行免疫荧光检查发现有免疫球蛋白和补体沉积，但胸腺切除术后并继续进行青霉胺治疗后，重症肌无力仍持续存在。整个过程中抗乙酰胆碱受体抗体均升高。该患者随后怀孕，从而能够对免疫球蛋白G（IgG）类抗乙酰胆碱受体抗体的胎盘转移进行研究。还观察到11例伴有青霉胺相关抗横纹肌抗体的类风湿性关节炎病例；其中3例有重症肌无力的证据。这些观察结果扩展了早期关于青霉胺与重症肌无力关联的报道，并表明抗横纹肌抗体、抗乙酰胆碱受体抗体和胸腺增生可能是青霉胺治疗的独立效应。
