Penicillamine and the Nephrotic Syndrome

IN THE TEN YEARS since Walshe¹first proposed the use of penicillamine, this chelating agent for copper has become the treatment of choice for hepatolenticular degeneration (Wilson's disease).²,³Penicillamine is also effective in the treatment of lead poisoning,⁴of cystinuria,⁵,⁶and, experimentally, of a number of other diseases, including rheumatoid arthritis.⁷Information about the drug's toxicity is, consequently, of more general interest than the rarity of hepatolenticular degeneration might indicate. Several undesirable side effects of penicillamine have been encountered: about one third of patients suffer from acute sensitivity reactions manifested by fever, urticarial rash, adenopathy, severe leukopenia, or thrombocytopenia²; reversible optic neuritis has been observed in two patients⁸,⁹; and painless, friable, pigmented, bullous lesions of skin, which is also often excessively wrinkled, have appeared in some patients after prolonged administration of more than 2 gm of penicillamine daily.² The most serious reaction