Systemic lupus erythematosus after thymectomy for myasthenia gravis: a case report and review of the literature.
Here, we report a case of systemic lupus erythematosus in a 13-year-old girl who developed the disease 3 years after thymectomy performed for the treatment of myasthenia gravis. The presenting symptoms were fever, generalized fatigability, bilateral loin pain, weight loss, arthralgia, hair loss, and recurrent painless mouth ulcers. Laboratory findings revealed proteinuria, hematuria, anemia, leucopenia, a high titer of antinuclear antibodies (ANA), anti-dsDNA, and decreased complement (C3 and C4) levels. There was minimal ascitis and pericardial effusion. Renal biopsy showed lupus nephritis class IV. The diagnosis of systemic lupus erythematosus was established based on the clinical and laboratory findings. The activity of systemic lupus erythematosus was controlled by pulsed treatment with methyl prednisolone followed by long-term oral glucocorticoid and immunosuppressive therapy. This study highlights the immune system derangement following thymectomy. It also examines the relevant literature.
Omar
Hyder A
HA
Department of Medicine, College of Medicine, King Khalid University, Asser Central Hospital, Abha, Kingdom of Saudi Arabia. [corrected]
Alzahrani
Mohammed A
MA
Al Bshabshe
Ali A A
AA
Assiri
Alhussain
A
Shalaby
Medhat
M
Dwedar
Ahmad
A
Abdulwahed
Saad Rezk
SR
Hussein
Mahmoud Rezk-Abd-Elwahed
MR
D000293:Adolescent; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000209:etiology*; D008775:Methylprednisolone / Q000627:therapeutic use; D009157:Myasthenia Gravis / Q000601:surgery*; D013934:Thymectomy / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D008775:Methylprednisolone