Case Report

Pure White Cell Aplasia and Immune Thrombocytopenia after Thymoma Resection: A Case Report and Review of the Literature

Table 2

Literature review of previous case reports for PWCA associated with thymoma. IVIg: Intravenous Immunoglobulins, G-CSF: Granulocyte Colony-Stimulating Factor.

StudyAckland et al. 1988 [18]Akinosoglou et al. 2014 [20]Al-mohareb et al. 1992 [22]Alvares et al. 2004 [21]Degos et al. 1982 [8]Desai et al. 2013 [23]Fumeaux et al. 2003 [13]Jethava et al. 2011 [24]

Patient age (gender)70 (female)70 (female)70 (male)59 (male)52 (female)73 (male)76 (female)45 (male)
Patient presentationNeutropenia
Pharyngeal candidiasis
Hypogammaglobulinemia
Sepsis (Pseudomonas aeruginosa)
Recurrent upper respiratory infections
Fatigue
Persistent fevers
Disseminated Cryptococcosis
Fatigue
Sweating
Chest pain
Productive cough
Intermittent fevers
Fever
Fatigue
Aphthous oral ulcers
Mild anemia
Agranulocytosis
Hypogammaglobulinemia
Severe recurrent infections (bacterial, mycotic, and parasitic)
Vomiting
Dyspnea
Dysphagia
Atrial Fibrillation
Abdominal Pain
Oral candidiasis
Productive cough
Fever
Fatigue
Diarrhea
Weakness
Weight loss
Odynophagia
Hyperglycemia
Hypoxia
Dyspnea
Oral ulcers
Tachycardia
Febrile neutropenia
Factor XI deficiency
Respiratory infection with lung nodules (Aspergillus fumigatus)
ComorbiditiesMyasthenia gravisObesity DyslipidemiaAutoimmune thyroiditis type 1 diabetesFactor XI deficiency
Histology of thymoma (type)Metastatic spindle cell thymomaSpindle cell thymoma (type A)Spindle cell thymoma (type A)Spindle cell thymoma (type A)Spindle cell thymoma (type A)Thymic carcinoma (type C)Malignant cortical thymoma (type B2)Thymoma (type AB)
Management (chronological)Broad spectrum antibiotics
Pyridostigmine
IVIg 0.4 g/kg/day
Broad spectrum antibiotics
Amphotericin B
G-CSF
IVIg dexamethasone
Acyclovir
Fluconazole
Broad spectrum antibiotics
Antifungal agents
Antiviral medications
Broad spectrum antibiotics
Antifungal agents
G-CSF (5 μg/kg/day) thymectomy
Plasmapheresis
Campath-1H 100 mg
Cyclosporin 150 mg bid
Mycophenolate mofetil 500 mg bid
Thymectomy
Plasmapheresis
Prednisone 1.5 mg/kg/day
Cyclophosphamide 2 mg/kg/day
IVIg 15 g/day
G-CSF thymectomy
Cyclosporin a 3 mg/kg/d (in two doses
Prednisone 1 mg/kg/d
Broad spectrum IV antibiotics & antifungals
IVIg 0.4 g/kg/d
G-CSF cyclosporine A
Thymectomy
Mortality outcomeDiedSurvivedDiedSurvivedSurvivedn/aSurvivedSurvived
CommentsPlasmapheresis Appeared to be the only effective treatmentIVIg and G-CSF were only effective when given with methylprednisone after thymectomy

StudyKobayashi et al. 2019 [25]Mathieson et al. 1990 [19]Okusu et al. 2016 [26]Oyenuga et al. 2021 [17]Uy et al. 2019 [7]Yip et al. 1996 (1/2) [12]Yip et al. 1996 (2/2) [12]
Patient age (gender)63 (male)36 (female)72 (male)64 (male)65 (female)51 (male)52 (female)
Patient presentationFebrile neutropenia
Hypogammaglobulinemia
Diarrhea
Gingivitis
Oral ulcers
Abdominal pain
Febrile neutropenia
Sore throat
Myocarditis
Oral candidiasis
Febrile neutropenia
Atrioventricular block
Hypogammaglobulinemia
Respiratory infection (Pseudomonas aeruginosa)
nasal congestion
Cough
Orthopnea
Diverticulitis
Gram-negative septic shock
Recurrent colitis
Hypogamma-globulinemia
Night sweats
Oral candidiasis
Febrile neutropenia
Truncal morbilliform rash
Hypogammaglobulinemia
Lung nodules (likely respiratory fungal infections)
Night sweats
Febrile neutropenia
Hypogamma-globulinemia
Upper respiratory tract infections
Lethargy
Oral ulcers
Sore throat
Weight loss
Oral candidiasis
Febrile neutropenia
ComorbiditiesMyasthenia gravisInflammatory bowel disease
Histology of thymoma (type)Spindle cell thymoma (type A)Thymoma (lymphoepithelial type)Thymoma (type 2B)Thymoma (type 2B)Thymoma (mixed type a and B2)Spindle cell thymoma (type A)Spindle cell thymoma (type A)
Management (chronological)Oral garenoxacin (by primary care physician)
G-CSF 5 μg/kg/d cyclosporin a 150 mg/d
Thymectomy
Plasmapheresis
Prednisolone 70 mg every other day
Azathioprine 2.5 mg/kg/d
Antibiotic therapy
IVIg
Thymectomy
IVIg
IVIg
G-CSF
thymectomy
Cyclosporin (target blood level 200–400 ng/mL)
Broad spectrum antibiotics
Prednisone 100 mg/d
G-CSF 150–600 μg/d
IVIg
GM-CSF 5–10 μg/kg/d methylprednisolone 1 g/d
Plasmapheresis
Thymectomy
IVIg 500 mg/kg/d
cyclophosphamide 100 mg/d
Mortality outcomeSurvivedSurvivedDiedSurvivedSurvivedSurvivedDied
CommentsPrednisone and azathioprine were the successful treatmentsNo specific treatment for PWCA since the patient developed AV block and shockThymectomy had no effect