Coexistence of rheumatoid arthritis, myasthenia gravis, and pemphigus superficialis

Abstract

D-Penicillamine (DP) is widely used nowadays in the treatment of rheumatoid arthritis, despite its well known side effects of an autoimmune nature, often associated with specific histocompatibility antigens (HLA). We report the case of a woman, suffering from rheumatoid arthritis (RA), treated with DP, who developed myasthenia gravis (MG) and pemphigus foliaceus (PF) and whose phenotype has only antigens usually associated with pemphigus. This may be the second published case of concurrent pemphigus and myasthenia gravis induced by D-penicillamine therapy, in the absence of thymoma.