Ptosis and Weakness after Start of D-Penicillamine Therapy

worldwide for the treatment of rheumatoid arthritis, de-spite the drug's formidable toxic potential. Most reports of adverse reactions to penicillamine have concerned its commonly encountered skin, renal, or hematopoietic tox-icity. More recently, several cases of myasthenia induced by penicillamine have been described (1-3). Our patient is 59 years old and has had active rheumatoid arthritis for more than 20 years. During the preceding year he had become progressively debilitated and developed chronic pressure sores. He was confined to bed or chair, but could stand without assistance. Hospitalization was prompted by the appearance of a large nonhealing ulcer over the left lateral malleolus. He had marked-ly deforming joint disease and advanced cushingoid features. For several years he had been treated with prednisone, 20 to 3