Pure Red Cell Aplasia That Developed 13 Years After Thymoma Treatment: A Case Report and Literature Review

Abstract

A 47-year-old woman was diagnosed with invasive thymoma 13 years ago. She had undergone repeated surgeries, as well as chemotherapy and radiation therapy. Chemotherapy was discontinued after the patient developed normocytic anemia, which was unresponsive to repeated blood transfusions. Bone marrow biopsy results revealed pure red cell aplasia (PRCA). Cyclosporine treatment led to improvement in PRCA; however, the patient died 3 years later from an invasive pneumococcal infection. The onset of thymoma-associated PRCA remains unpredictable, and a significant delay may occur between the diagnosis of the two conditions.

Keywords: cyclosporine; pure red cell aplasia; thymoma.

FIGURE 1

Clinical course of thymoma‐associated PRCA. The changes in hemoglobin concentrations are relative to the final administration date of carboplatin + paclitaxel as the reference point. Anemia did not improve despite cessation of chemotherapy and multiple blood transfusions but improved after starting cyclosporine.

FIGURE 2

Chest and abdominal CT images prior to bone marrow biopsy. (a) Multiple pulmonary masses in the right lung. (b) Pleural masses with evidence of liver invasion. No other distant metastases were observed.

FIGURE 3

Hematoxylin–eosin staining and immunohistochemical findings of the bone marrow specimen showed granulocytes (positive for myeloperoxidase [MPO]) and megakaryocytes (positive for CD42b) but no erythroblasts (negative for glycophorin C).