A case of D-Penicillamine induced polymyositis

• Published in: Japanese Journal of Clinical Immunology Vol. 8; no. 6; pp. 374 - 381
• Main Authors: Katsube, Tomoko, Nagaoka, Saburo, Miki, Tomohiro, Sakane, Tsuyoshi, Tsunematsu, Tokugoro, Yamauchi, Yasutaka, Kobayashi, Shotai
• Format: Journal Article
• Language: English
• Published: The Japan Society for Clinical Immunology 1985
• Subjects: D-Penicillamine; Polymyositis (PM); Progressive systemic sclerosis (PSS)
• ISSN: 0911-4300; 1349-7413; 1349-7413
• DOI: 10.2177/jsci.8.374

A case of D-Penicillamine induced polymyositis in progressive systemic sclerosis. Nowadays D-Penicillamine (D-PC) is widely used for treatment of rheumatoid arthritis. It is also employed to treat patients with progressive systemic sclerosis (PSS) from viewpoints of favorable pharmacological effects on such as inhibition of collagen synthesis and modulation of deranged immune functions. Although various side-effects have been reported up-to-date, much attention has not paid on occurrence of polymyositis in D-PC treatment. We experienced a case of PSS who had manifested a typical polymyositis during D-PC treatment and bad recovered completely from it on discontinuance of the drug. A 51-year-old woman was admitted to another hospital because of Raynaud's phenomenon and sclerodactylia. She was treated with glucocorticoids for several months. With a slight improvement of the symptoms she discharged from it and stayed at home. She, thereafter, became gradually aggravated and started to complain of severe dyspnea. She was admitted to our University Hospital. As chest X-ray showed a marked pulmonary fibrosis, D-PC was given in a dose of 100mg daily for 4 weeks and then in a dose of 200mg daily. During the treatment, she complained of myalgia and muscle weakness accompanied with elevated values of serum creatinine phosphokinase (CPK) and aldolase (ALD). Electromyogram and muscle biopsy showed findings compatible with polymyositis. One month after discontinuation of D-PC, physical and laboratory abnormalities of polymyositis were completely normalized. We concluded that polymyositis seen in this patient could have been induced with D-PC, aparting from a notion that D-PC had manifested latent polymyositis included in a morbid spectrum of PSS.