A case of thymoma with pure red cell aplasia and myasthenia gravis

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  • 赤芽球癆と重症筋無力症を合併した胸腺腫の1例

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Abstract

<p>We report a case of pure red cell aplasia (PRCA) and myasthenia gravis (MG) during treatment for thymoma. A 67-year-old female underwent extended thymectomy with partial resections of both upper lobes of the lungs, left phrenic nerve, and pericardium for Masaoka stage IVa thymoma in September 2013 after steroid pulse therapy. After 4 cycles of postoperative chemotherapy with carboplatin and nab-paclitaxel, additional resection was performed for the residual disseminations. The patient followed a favorable course until September 2015, when recurrence of right pleural disseminations was detected. She was re-administered 4 cycles of carboplatin and nab-paclitaxel, followed by maintenance therapy with nab-paclitaxel. In February 2016, she developed severe anemia and was diagnosed with PRCA by bone marrow biopsy. Although anemia was improved by the administration of prednisolone, it was discontinued in April 2017 because of side effects of pulmonary artery thromboembolism, cataract, and osteoporosis. In July 2019, diplopia appeared, and MG was diagnosed. She was started on pyridostigmine bromide and tacrolimus. In February 2021, tacrolimus was discontinued and cyclosporine was introduced because of the recurrence of PRCA. After three weeks, anemia improved and there was no relapse of MG. As of January 2022 (8 years and 4 months after the first surgery), she was following a favorable course as a tumor-bearing patient with good ADLs (Activities of Daily Living).</p>

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