Rare association of thymoma, myasthenia gravis and sarcoidosis : a case report

Mohankumar Kurukumbi¹ , Roger L Weir¹ , Janaki Kalyanam² , Mansoor Nasim³ and Annapurni Jayam-Trouth¹

¹Department of Neurology, Howard University Hospital, Georgia Avenue NW, Washington, DC 20060, USA

²Department of Physical Medicine and Rehabilitation, Howard University Hospital, Georgia Avenue NW, Washington, DC 20060, USA

³Department of Pathology, Howard University Hospital, Georgia Avenue NW, Washington, DC 20060, USA

author email corresponding author email

Journal of Medical Case Reports 2008, 2:245doi:10.1186/1752-1947-2-245


Published:	25 July 2008

Abstract

Introduction

The association of thymoma with myasthenia gravis (MG) is well known. Thymoma with sarcoidosis however, is very rare. We presented an interesting case with coexisting thymoma, MG and sarcoidosis.

Case presentation

A 59-year-old female patient with a history of sarcoidosis was admitted to the hospital with a one-day history of sudden onset of right-sided partial ptosis and diplopia. Neurosarcoidosis with cranial nerve involvement was considered, but was ruled out by the clinical findings, and MG was confirmed by the positive tensilon test, electrophysiological findings and positive acetylcholine receptor binding antibodies. On further evaluation, a CT chest scan showed a left anterior mediastinal mass and bilateral lymphadenopathy. Post surgical diagnosis confirmed the thymoma and sarcoidosis in the lymph nodes.

Conclusion

When two or more diseases of undetermined origin are found together, several interesting questions are raised. It is important to first confirm the diagnoses individually. Immunologic mechanisms triggering the occurrence of these diagnoses together, are difficult to address. Although the coexistence of thymoma, MG and sarcoidosis may be coincidental, it is noteworthy to report this case because of the multiple interesting features observed as well as the rarity of occurrence.