A Case of Myasthenia Gravis (M. G. ) Complicated with Recurrent Invasive Thymoma

• Published in: Japanese Journal of National Medical Services Vol. 38; no. 9; pp. 920 - 923
• Main Authors: MATSUMOTO, Shin, KONISHI, Hiroshi, OKA, Akira, KIBATA, Masayoshi, IHARA, Yuetsu, NANBA, Reiko
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 1984
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.38.920

Total thymectomy for M. G. is a widely established surgical treatment since M. G. is not infrequently complicated with thymic disorders. We present a case of recurrent thy-moma where thymectomy didn't result in clinical improvement. This 35 years old female patient who at first complained of cervical asthenia, which subsequently progressed to bulbar symptoms was well responsive to anti-cholinergic agent. Thymectomy for compli-cated thymoma was then performed eight months later, Oct. 1978. The operative finding revealed thymoma partially invaded into left side pleura which had been completely removed. The postoperative course was not uneventful, i. e., dependance on anti-cholinergic agent and moderate general myasthenia which exacerbated during menstrual period were still on its way. In December 1978, she developed several bouts of myasthenic crisis which required intensive care under mechanical ventilation. The intensive treatment included the administration of high-dose corticosteroid, immu-nosuppressant and the use of plasmapheresis. Although serum anti-acetylcholine receptor antibody titer showed significant decrease following immunosuppresion and plasmapheresis, she could not get weaned from mechanical ventilation for another four years. Four years after first operative treatment, she underwent second surgical resection for the remnant of the invasive thymoma including adipose tissue at the anterior mediastinum which was diagnosed by chest computed tomography. Three months following the second surgical procedure she could successfully get wean-ed from the ventilator for only four weeks in spite of the significant decrease of serum anti-acetyl choline antibody titer postoperatively. She has been so far on ventilator up to present time, This is a case report suggesting that M. G. is not necessarily a thymocentric disease.