Post-thymectomy myasthenia gravis: a case report and systematic review of literature. Issue 12 (2nd December 2021)

• Record Type: Journal Article
• Authors: Gurowich, Louise; Yiin, Gabriel; Maxwell, Adam; Rice, Alexandra
• Is Part Of: BMJ case reports. Volume 14:Issue 12(2021)
• Publication Date: 2021-12-02
• Subjects: neurology -- neuromuscular disease -- endocrine cancer -- cardiothoracic surgery; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-246005
• Languages: English
• ISSNs: 1757-790X

Abstract

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.