Granulocytic leukemia associated with myxedema thyroiditis and myasthenia gravis.

Abstract

A case of myxedema associated with Hashimoto's thyroiditis, myasthenia gravis, and granulocytic leukemia is described. The patient had the classical symptoms and signs of hypothyroidism. Profound myopathy, ptosis, and bulbar signs suggested myasthenia gravis and the diagnosis was confirmed by an anticholinesterase test. Treatment with cholinesterase inhibitors was ineffective and ACTH was given for increasing bulbar signs and ventilatory failure. Severe pneumonia supervened and was thought to be the cause of a striking leukemoid blood picture. However, the leukemoid picture persisted after the pneumonia cleared. While convalescing, the patient died suddenly. At autopsy, granulocytic infiltrates of several organs and a hypercellular bone marrow with a preponderance of granulocytes, a decrease in erythrocytic elements and virtual absence of megakaryocytes were consistent with a diagnosis of granulocytic leukemia. The thyroid disease and the myasthenia gravis may have had an immunological basis and this may also have played a role in the development of the granulocytic leukemia.