PENICILLAMINE-INDUCED PSEUDO-PSEUDOXANTHOMA ELASTICUM IN A PATIENT WITH RHEUMATOID-ARTHRITIS

Penicillamine is a heavy metal chelator which is used in the treatment of Wilson''s disease, cystinuria, rheumatoid arthritis and scleroderma. The cutaneous side-effects of prolonged, high dose (1-2 g/day) treatment include skin fragility, elatosis perforans serpiginosa (EPS), cutis laxa and rarely pseudoxanthoma elasticum-like changes. We describe the clinical and post-mortem findings in a patient who developed pseudo-pseudoxanthoma elasticum and multi-system penicillamine-induced elastosis while taking D-penicillamine (750 mg/day). There are no previous reports of penicillamine-induced elastic tissue damage in a patient with rheumatoid arthritis.