LATE-ONSET IMMUNODEFICIENCY IN A PATIENT WITH RECURRENT THYMIC CARCINOMA AND MYASTHENIA-GRAVIS

The most common autoimmune disease associated with thymoma is myasthen ia gravis, In addition, cellular and humoral immune defects have been frequently reported in association with thymic neoplasms. Here we repo rt the case of a patient with myasthenia gravis receiving long-term im munosuppression with azathioprine and recurrent well-differentiated th ymic carcinoma who developed CD4+ T-cell depletion and CNS cryptococco sis after multiple courses of chemotherapy and mediastinal irradiation . We hypothesize that in thymectomized patients bone marrow suppressio n and abrogation of the peripheral T-cell pool can result in a delayed T-cell regeneration due to the lack of functional thymic epithelium. (C) 1998 Elsevier Science B.V.