Thymoma with Paraneoplastic Myasthenia Gravis

Authors

Dallin Beus, HCA HealthcareFollow
Sherwin Thomas, HCA HealthcareFollow
Amnah Andrabi

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2024

Keywords

myasthenia gravis, autoimmune diseases

Disciplines

Immune System Diseases | Internal Medicine | Medicine and Health Sciences | Neoplasms

Abstract

Background: Myasthenia gravis is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigue. Paraneoplastic myasthenia gravis, a rare manifestation of this condition, is often associated with underlying malignancies, such as thymic tumors. We present the case of a 51-year-old female patient with a mediastinal mass who developed paraneoplastic myasthenia gravis, highlighting the diagnostic challenges and therapeutic considerations in such cases. Case Description: A 51-year-old female presented with a one-month history of progressive muscle weakness, diplopia, and dysphagia. Clinical examination and serological tests led to the diagnosis of myasthenia gravis. Computed tomography (CT) imaging revealed a 6 cm mediastinal mass, suggestive of a thymic tumor. Further workup, including histopathological examination, confirmed a thymic carcinoma as the underlying malignancy. This case highlights the complex interplay between thymic tumors and myasthenia gravis, suggesting a paraneoplastic origin. Treatment and Outcome: The patient was initiated on treatment with acetylcholinesterase inhibitors and corticosteroids for myasthenia gravis, with concurrent intravenous immunoglobulin (IVIG) therapy. Subsequently, she underwent a thymectomy, and adjuvant chemotherapy was administered for the thymic carcinoma. The patient's recovery was uneventful, with no postoperative myasthenic crisis observed. Over time, her muscle strength improved, and she achieved symptomatic remission of myasthenia gravis. Regular follow-up revealed no evidence of tumor recurrence, and the patient remained free of myasthenia gravis-related symptoms. Conclusion: This case report highlights the importance of considering paraneoplastic myasthenia gravis in patients with mediastinal masses, especially thymic tumors. Prompt diagnosis and multimodal treatment, including thymectomy, IVIG therapy, and oncological therapy, are crucial in managing these complex cases. Timely recognition and intervention are pivotal in achieving favorable clinical outcomes for patients with this rare and challenging association. The addition of IVIG therapy appears to be beneficial in reducing the risk of postoperative myasthenic crises in these patients.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Beus, Dallin; Thomas, Sherwin; and Andrabi, Amnah, "Thymoma with Paraneoplastic Myasthenia Gravis" (2024). North Texas GME Research Forum 2024. 60.
https://scholarlycommons.hcahealthcare.com/northtexas2024/60