Case Reports in Hematology

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.


Study	Ackland 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 presentation	Neutropenia 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)
Comorbidities	Myasthenia gravis	Obesity Dyslipidemia	—	—	—	—	Autoimmune thyroiditis type 1 diabetes	Factor XI deficiency
Histology of thymoma (type)	Metastatic spindle cell thymoma	Spindle 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 outcome	Died	Survived	Died	Survived	Survived	n/a	Survived	Survived
Comments					Plasmapheresis Appeared to be the only effective treatment		IVIg and G-CSF were only effective when given with methylprednisone after thymectomy

Study	Kobayashi 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 presentation	Febrile 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
Comorbidities	—	Myasthenia gravis	—	Inflammatory 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 outcome	Survived	Survived	Died	Survived	Survived	Survived	Died
Comments		Prednisone and azathioprine were the successful treatments	No specific treatment for PWCA since the patient developed AV block and shock			Thymectomy had no effect