It has been long considered that d-penicillamine may induce various autoimmune conditions, including myasthenia gravis (MG), whereas early observations suggested that about 1.5% of patients with systemic sclerosis (SSc) develop MG. Along this line it has been thought that the association of SSc and MG was due to d-penicillamine, which was the standard therapy for SSc in the past. We report a 66-year-old woman with SSc who developed MG in the absence of d-penicillamine exposure. We found seven other similar cases in the literature, as well as seven additional cases in whom SSc followed MG. Since it has been clear now that different autoimmune diseases frequently cluster within families, we suggest a true association of these two autoimmune diseases which could be under-reported.
SteenVDBlairSMedsgerTAJrThe toxicity of D-penicillamine in systemic sclerosis.Ann Intern Med1986;104 (5):699–705
5.
ZivkovićSAMedsgerTAJrMyasthenia gravis and scleroderma: two cases and a review of the literature.Clin Neurol Neurosurg2007;109 (4):388–391
6.
NacuAAndersenJBLisnicVOweJFGilhusNEComplicating autoimmune diseases in myasthenia gravis: a review.Autoimmunity2015;48 (6):362–368
7.
KuoC-FMatthewJGraingeAna MValdesLai-Chu SeeShue-FenLuoKuang-Hui Yu, Weiya Zhang, Michael Doherty.Familial Aggregation of Systemic Lupus Erythematosus and co-aggregation of autoimmune diseases in affected families. JAMA Intern Med2015;175 (9):1518–1526
8.
KuoC-FMatthewJGraingeAna MValdesLai-Chu SeeShue-FenLuoKuang-HuiYuWeiyaZhang and MichaelDohertyFamilial risk of Sjogrens Syndrome and co-aggregation of Autoimmune diseases in affected families.ARTHRITIS & RHEUMATOLOGY2015;67 (7):1904–1912
9.
Fridkis-HareliMImmunogenetic mechanisms for the coexistence of organ-specific and systemic autoimmune diseases.J Autoimmune Dis2008;5 (1):1
KomalKumar RNPatilSATalyABNirmalaMSinhaSArunodayaGREffect of D-penicillamine on neuromuscular junction in patients with Wilson disease.Neurology2004;63 (5):935–936
12.
UonoMIrieMMinodaKSakimotoTCase of myasthenia gravis fing thyroidectomy in Basedow's disease and later complicated by systemic sclerosis.Shinkei Kenkyu No Shimpo1971;15 (4):819–23
13.
MitchellGWLichtenfeldPJMcDonaldCJMyasthenia gravis and scleroderma. An unusual combination of diseases.JAMA1975;233 (6):531
14.
BhallaRSwedlerWILazarevicMBAjmaniHSSkoseyJLMyasthenia gravis and scleroderma.J Rheumatol1993;20 (8):1409–1410
15.
WerneckALCheccacci-BalodTTumaGScleroderma, thyroiditis, and myasthenia gravis: study of a case.Arq Neuropsiquiatr1993;51 (4):549–553
16.
Hausmanowa-PetrusewiczIBlaszczykMJablonskaSCoexistence of scleromyositis associated with PM-Scl antibody and myasthenia.Neuromuscul Disord1995;5 (2):145–147
17.
ArosteguiJGorordoJMAramburuJMMyasthenia gravis and scleroderma.J Rheumatol1995;22 (4):792–793
18.
KambaraCKinoshitaIAmenomoriTEguchiKYoshimuraTMyasthenia gravis associated with limited scleroderma (CREST syndrome).J Neurol2000;247 (1):61–62
19.
KimHSChunYSHannSKParkWHA case of linear scleroderma and myasthenia gravis.J Dermatol2000;27 (1):31–34
20.
de WazieresBFraisseTCdi CastriADamignyAFourcadeJMyasthenia associated with systemic scleroderma.Rev Med Intern2002;23 (4):403404
21.
HibinoNTakegamiTSystemic sclerosis complicated with left trigeminal neuropathy and myasthenia gravis during a period of six years after onset.Nippon Naika Gakkai Zasshi2003;92 (12):2423–2425
22.
ParraVDribanNBassottiALocalized morphea and myasthenia gravis [e-pub].J Am Acad Dermatol2003;49e5
23.
FerriCColaciMBattollaLGiuggioliDSebastianiMThymus alterations and systemic sclerosis.Rheumatology (Oxford)2006;45 (1):72–75
