Abstract Details

Title A Rare Hematologic Presentation of a Patient with Myasthenia Gravis Status Post Thymectomy

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 11-011

Objective

Case report

Background Hematological side effects of a thymectomy are important to consider in myasthenia gravis (MG) patients who are candidates for thymoma resection. We report a case of a patient with MG who underwent a thymectomy and presented to the emergency department (ED) about one year later with low hemoglobin and a normocellular bone marrow with suspected developing pure red cell aplasia (PRCA) versus autoimmune related peripheral destruction of red blood cells.

Design/Methods

Patient was a 52-year-old male with a history of MG on pyridostigmine status post thymectomy 1 year ago, presenting to the ED with complaints of 2 weeks of shortness of breath, cough, and found to be severely anemic with a hemoglobin of 2.4 g/dL. Physical exam was notable for conjunctival pallor and jugular venous distention. Treatment upon admission included transfusion of packed red blood cells with IV Lasix, pyridostigmine, and high dose prednisone.

Results Labs showed Hemoglobin 2.4 g/dL, MCV 120 fL, reticulocyte count 0.29%, LDH 370 U/L, total iron 202 µg/dL, iron saturation 61%, Ferritin 398 µg/dL, and TIBC 129 µg/dL. B12 and B9 within normal limits (WNL). Chest CT showed trace hazy soft tissue stranding across mediastinum representing residual thymic tissue versus post-surgical changes. Direct Coombs Test was negative, IgG and IgA (WNL), and IgM low normal. Urine protein electrophoresis was normal and kappa/lambda was 1.73. Antinuclear antibodies and antimitochondrial antibodies were negative. Peripheral blood smear showed concern for possible hairy cell. MDS FISH panel was negative. EGD/colonoscopy showed no source of bleeding. Bone marrow biopsy showed concern for early evolving PRCA due to decreased erythroid precursors.

Conclusions

With thymectomy becoming more common in the treatment of MG, this case provides insight into potential hematological sequelae post-surgery. Prior studies have highlighted the occurrence of aplastic anemia after thymectomy, but other postoperative hematological manifestations have not been explored.

Authors/Disclosures
Ayesha Quadri PRESENTER	Ms. Quadri has nothing to disclose.
Hafiz Fadl, MD	Dr. Fadl has nothing to disclose.
Scott F. Cooper, MD	Dr. Cooper has nothing to disclose.

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