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Case report
Post-thymectomy myasthenia gravis: a case report and systematic review of literature
  1. Louise Gurowich1,2,
  2. Adam Maxwell2,
  3. Alexandra Rice3 and
  4. Gabriel Yiin2
  1. 1General Surgery, Taunton and Somerset NHS Foundation Trust, Taunton, UK
  2. 2Neurology, Swindon and Marlborough NHS Trust, Swindon, UK
  3. 3Histopathology, Royal Brompton Hospital, London, UK
  1. Correspondence to Louise Gurowich; louise.gurowich{at}nhs.net

Abstract

Myasthenia gravis (MG) is an autoimmune condition affecting the neuromuscular junction characterised by weakness and fatiguability, carrying a high morbidity if treatment is delayed. A clear association with thymoma has led to management with thymectomy as a common practice, but MG presenting post-thymectomy has rarely been reported. We present a case of an 82- year-old woman developing fatigue, ptosis and dysarthria 3 months after thymectomy. After a clinical diagnosis of MG was made, she responded well to prompt treatment with prednisolone and pyridostigmine. Her anti-acetylcholine receptor antibody (anti-AChR) subsequently came back positive. Our systematic review reveals that post-thymectomy MG can be categorised as early-onset or late-onset form with differing aetiology, and demonstrated correlation between preoperative anti-AChR titres and post-thymectomy MG. The postulated mechanisms for post-thymectomy MG centre around long-lasting peripheral autoantibodies. Clinicians should actively look for MG symptoms in thymoma patients and measure anti-AChR preoperatively to aid prognostication.

  • neurology
  • neuromuscular disease
  • endocrine cancer
  • cardiothoracic surgery

http://dx.doi.org/10.1136/bcr-2021-246005

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    Footnotes

    • Contributors LMG, AM and GY cared for the patient on their admission with the acute case as described above. AR analysed the specimen from the patient’s operation and provided a histology report. AM discussed with the patient and analysed the inpatient notes, compiling the case history, and obtained consent for the report including the patient reviewing the manuscript. LG reviewed available literature to analyse existing data and wrote the discussion portion of the report. GY supervised the case report throughout. All authors (LMG, AM, GY and AR) reviewed the manuscript and provided critical feedback.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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