Thymoma associated with fatal myocarditis and polymyositis in a 58-year-old man following treatment with carboplatin and paclitaxel: A case report

Abstract

Abstract.We report the case of a 58-year-old male presenting with giant cell myocarditis and myositis associated with thymoma following treatment with carboplatin and paclitaxel. The patient was diagnosed as having stage IVa thymoma. Acetylcholine receptor binding antibody titers were positive at 42 nmol/l, although the patient exhibited no symptoms of myasthenia gravis (MG). The patient was treated with a combination of carboplatin and paclitaxel. However, 18 days following administration of this second cycle of chemotherapy, the patient developed a low-grade fever. Twenty-one days after receiving the second cycle of chemotherapy, the patient was admitted to the Nagoya City University Medical School complaining of general fatigue. Serum levels of creatinine phosphokinase (7,271 U/l), alanine aminotransferase (469 U/l) and aspartate aminotransferase (561 U/l) were elevated. Electromyography revealed no evidence of a neuromuscular junction defect or myopathic process. The patient developed progressive muscle weakness and succumbed to the disease in hospital on day 9. An autopsy revealed thymoma invasion of the left parietal and visceral pleura, pericardium and diaphragm. Numerous skeletal muscle groups and myocardium exhibited diffuse lymphocytic infiltration. Although it has been suggested that myocardial disorders may occur in patients with thymoma and/or MG, the mechanism involved remains unknown. This second report may provide new data regarding giant cell myocarditis and myositis associated with thymoma following treatment with carboplatin and paclitaxel.

Myocarditis

“…Yet, patients who present with giant cell myocarditis and eosinophilia myocarditis are at high risk of downstream difficulties. These patients may also present with thymoma, 40,41 autoimmune disorders, 42 ventricular tachyarrhythmia, or advanced heart block. Moreover, for patients who fail to respond positively to standard supportive care, cardiac sarcoidosis should be considered in patients with DCM, chronic HF, or ventricular arrhythmias.…”

Cardiac involvements in myasthenia gravis associated with anti‐Kv1.4 antibodies

“…It has been demonstrated that anti-Kv1. Amongst approximately 20 previously reported cases showing a syndrome of myocarditis, MG and thymoma, 11 of the cases were reported in the English literature, and clinical information was available for all 11 of these cases [19][20][21][22][23][24][25][26][27][28][29]. The characteristics of clinically suspected myocarditis were common between these patients and our series.…”

Giant cell myositis responsive to combined corticosteroids and immunoglobulin

“…However, it is critically important to start immunotherapy immediately upon suspicion, as the associated myocarditis is often rapidly fatal due to lethal arrhythmias and congestive heart failure 7 8. Myasthenia gravis with myositis and cardiac involvement can respond well to oral and intravenous corticosteroids, tacrolimus and plasma exchange;2 9 the therapeutic choice can be driven by the presence of myasthenic crisis.…”