Abstract
Three patients with thymoma associated myasthenia gravis complicated by the nephrotic syndrome are described. There were two male and one female patients with a mean age at presentation of 55.6 years (27–75). In all cases anti striated‐muscle and acetylcholine‐receptor antibodies were present. Thymectomy was performed 1.4 years (1–3) after diagnosis of myasthenia gravis; histology revealed invasive mixed lymphocytic/epithelial (1), invasive epithelial (1) and non‐invasive lymphocytic/epithelial (1) cell thymoma. All patients were receiving pyridostigmine, prednisolone and azathioprine at the time nephrotic syndrome developed (a mean of 2 years after thymectomy). Renal biopsy demonstrated a minimal change nephropathy alone in all three. Remission following increased steroids occurred in two despite continuing azathioprine. Myasthenic symptoms remained stable throughout. The third patient died 3 weeks after onset of nephrotic syndrome. The cause of the nephrotic syndrome is uncertain, but an immune mechanism, possibly in genetically predisposed individuals, is perhaps most likely.
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