Abstract
Background: Paraneoplastic gastroparesis is a gastrointestinal syndrome that rarely precedes a tumor diagnosis. To increase awareness of this rare clinical entity, we present a case of severe gastroparesis, which was later proven to be associated with a thymoma. Case report: A 55-year old man had the sudden onset of severe abdominal cramps and abdominal distension, early satiety with postprandial nausea, acid regurgitation, belching, and flatulence. He lost about 20 pounds. The physical and imaging examination revealed stomach distension, gastroparesis, and the presence of a solid mass in the anterior mediastinum. Radical surgery was performed to remove the thymoma and, given the high value of Mib-1, the patient was submitted to postoperative chest radiation therapy. After thymectomy, a diagnosis of paraneoplastic myasthenia gravis with subacute autonomic failure was made. Conclusion: Autoimmune gastroparesis should be considered as a potential paraneoplastic syndrome in patients with thymoma, myasthenia gravis, and delayed gastric emptying in the absence of mechanical obstruction.
Highlights
A diagnosis of thymoma is made in 10–15% of patients with myasthenia gravis (MG) [1]
We report a rare case of thymoma associated with MG and paraneoplastic autoimmune gastrointestinal dysmotility (AGID), We report a rare case of thymoma thymoma associated with MG and paraneoplastic paraneoplastic AGID, AGID, which remained long after thymectomy (Figure 3)
Gastroenteric neuropathies are not typical of MG, and AGID has been associated with some cancers such as lung adenocarcinoma, small cell lung cancer and ovarian cancer
Summary
A diagnosis of thymoma is made in 10–15% of patients with myasthenia gravis (MG) [1]. Dysautonomia is not necessarily a feature of MG, the latter being associated with gastrointestinal autonomic failure only in some rare cases of thymoma Such an association was the basis of gastroparesis in a patient described by Tabbaa et al [2] who reported a slow recovery only after thymectomy. Thymoma-associated MG was considered the cause of intestinal pseudo-obstruction in two patients described by Anderson et al [4] Starting from their case series, Vernino et al [5] assumed that paraneoplastic. MG may trigger autonomic symptoms, such as autoimmune gastrointestinal dysmotility (AGID), by means of autoantibodies against ganglionic acetylcholine receptors (AChRs), as the symptom relief following the anticholinesterase (pyridostigmine) treatment suggested Even in this experience, a case of gastroparesis as the clinical presentation of AGID faded with thymectomy.
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