RT Journal Article SR Electronic T1 Persistent type 2 respiratory failure on background of advanced thymoma with lung metastases JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e231690 DO 10.1136/bcr-2019-231690 VO 12 IS 11 A1 Abrar Munir A1 Mohsin Ijaz Khan A1 Jason Kah Chun Cheong YR 2019 UL http://casereports.bmj.com/content/12/11/e231690.abstract AB We report a patient in her 60s with history of end-stage thymoma with bilateral lung metastases on palliative chemotherapy presented to the hospital with sudden shortness of breath initially treated for probable pulmonary embolism (PE) pending CT of the pulmonary arteries which was subsequently negative for PE. During this admission, she developed transient right-sided facial droop and slurred speech which resolved spontaneously; however, the patient became unresponsive and desaturated with severe decompensated type 2 respiratory failure. Patient was supported with non-invasive ventilation (biphasic positive airway pressure) for few days. Myasthenia gravis was suspected due to clinical features and confirmed by the high titre of acetylcholine receptor antibody titre.