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Case report
Double hit: Evans syndrome after malignant thymoma treatment and parvovirus B19 infection
  1. John Xie1,
  2. Gerard Chaaya2,
  3. Rachna Jetly-Shridhar3 and
  4. Thomas Stewart Atkinson2
  1. 1Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
  2. 2Internal Medicine, Division of Hematology and Medical Oncology, Tulane University School of Medicine, New Orleans, Louisiana, USA
  3. 3Pathology, LSUHSC, New Orleans, Louisiana, USA
  1. Correspondence to Dr Thomas Stewart Atkinson; tatkins1{at}


Malignancies are often associated with autoimmune diseases, which are addressed by treating the underlying cancer. However, there are rare malignancies that can cause autoimmune diseases even after appropriate treatment. Our patient is a 39-year-old Hispanic man with a malignant thymoma recently treated with chemotherapy and radiation who presented with syncope and dyspnoea. He was found to be both anaemic and thrombocytopenic. His labs were consistent with autoimmune haemolytic anaemia (AIHA), except his reticulocyte count was unexpectedly low. Bone marrow biopsy supported a diagnosis of Evans syndrome, a rare autoimmune condition characterised by (AIHA) combined with immune thrombocytopenia. He was also found to have an acute parvovirus B19 infection. He was treated with steroids and RBC transfusion. His blood counts gradually returned to baseline, with improvement in symptoms. This patient’s thymoma treatment and active parvovirus B19 infection likely both played a role in the development of Evans syndrome.

  • oncology
  • haematology (incl blood transfusion)
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  • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. TSA, GC, and RJ-S were involved with the clinical care of the patient and were responsible for the conception and development of the article. JX and GC were responsible for drafting the manuscript. TSA and RJ-S were responsible for reviewing, editing and approving the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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