An unusual presentation of thymoma: dysgeusia, ulcerative colitis, keratoconjunctivitis sicca, autoimmune retinopathy and myasthenia gravis

Abstract

A 41-year-old female presented with dysgeusia, dry eyes, nyctalopia with progressive visual field constriction (due to autoimmune retinopathy) and gastrointestinal symptoms (due to ulcerative colitis). She was subsequently admitted to intensive care with a myasthenic crisis, and CT of the thorax demonstrated a thymoma.Following thymectomy and adjuvant radiotherapy, she has remained in complete remission from her ulcerative colitis and myasthenia gravis, her retinopathy has stabilised and there has been no thymoma recurrence over a 10-year postoperative period. There was a brief relapse of her dysgeusia (causing weight loss) and dry eye symptoms 3 years after her surgery, which resolved 8 months later. While the association of thymomas with paraneoplastic syndromes (PNS) is well established, it is unusual to present with multiple PNS, and some of these have only been documented in sparse case reports to date. Thymectomy played a crucial role in improvement and stabilisation of her PNS.

Keywords: immunology; neuroopthalmology; respiratory cancer; retina; ulcerative colitis.

Figure 1

Contrast-enhanced CT thorax scan showing a 4.5 cm×5.5 cm anterior mediastinal mass.

Figure 2

Humphrey 24–2 visual fields showing bilateral ring scotoma: (A) left eye visual field; (B) right eye visual field; (C) left eye visual field 5 years following visual field A, showing stabilisation of ring scotoma; (D) right eye visual field 5 years following visual field B, showing stabilisation of ring scotoma.

Figure 3

Colour fundus photograph showing subtle parafoveal retinal pigment epithelium mottling with otherwise normal optic discs and vessels.

Figure 4

Left-hand images: infrared image of the macula of the right eye (top) and left eye (bottom), respectively. Right-hand image: optical coherence tomography scan corresponding to macula area shown on the left, showing parafoveal loss of the outer retina layers (loss marked by white arrows). Top image, RE; bottom image, LE. LE, left eye; RE, right eye.