A Case of Thymoma with Multiple Autoimmune Presentations

Abstract

A 40 year old female presented with a history of cough for 1.5 years and diarrhea for 5 days. She further had a history of pinkish discoloration of skin and red-crusted papules on the anterior and posterior parts of the trunk. Chest X-ray and chest CTScan revealed focal nodular densities in lung besides an anterior mediastinal mass. The mediastinal mass was surgically removed and the pathologic diagnosis was a lymphocytic type of thymoma (Fig. 1). Laboratory data showed low albumin (2.9 gr/dl), high alkaline phosphatase (1448 units/l), high SGOT and SGPT (107 units/l and 128 units/l, respectively) with total billirubin of 1.38 (mg/dl), direct billirubin of 0.52 (mg/dl) and <span style="font-family: Symbol; font-size: medium;"><span style="font-family: Symbol; font-size: medium;">γ</span></span><span><span>Gt: 440 (Normal < 40). Other positive findings included ANA:</span></span> 1/640 speckled pattern, low hemoglobin: 9.1 (g/dl), mild eosinophilia (595/mm <span style="font-family: Times New Roman; font-size: small;"><span style="font-family: Times New Roman; font-size: small;">3</span></span><span><span>) and</span></span> positive occult blood in stool, with normal WBC, BUN, Na, K, Ca, PO4 and uric acid. Serum immunoelectrophoresis, abdominal sonography, fine needle aspiration of liver and endoscopic retrograde cholongiography were all normal. The report of skin biopsy indicated a lichen planus bolus type lesion. Colonoscopy detected points of inflammation with thick mucosa and biopsy was in favor of ulcerative colitis. Due to severe photophobia, she had previously consulted with an ophthalmologist revealing keratoconjuctivits sicca due to dry eye. Four months later, she was expired due to severe pneumonia and sepsis.