Acute Autoimmune Hepatitis, Myositis, and Myasthenic Crisis in a Patient with Thymoma

Avelumab for metastatic or locally advanced previously treated solid tumours (JAVELIN Solid Tumor): a phase 1a, multicohort, dose-escalation trial

“…Of 18 patients treated in the dose-limiting toxicity analysis set, no dose-limiting toxicities were noted at dose levels 1, 2, or 3, and one dose-limiting toxicity was reported at dose level 4 in a patient with metastatic thymoma. The array of symptoms that this patient had irrespective of treatment included myositis, neurological dysfunction, and transaminitis, as previously described 17–20 (classified as autoimmune disorder in table 2), and increased blood creatine phosphokinase. All dose levels had fewer than two dose-limiting toxicities; thus, the maximum tolerated dose was not reached.…”

“…However, autoimmune disorders are a commonly recognised feature of thymic tumours. 17–20 The other partial response occurred in a patient with adrenocortical carcinoma. Additionally, stable disease was recorded in 30 of 53 patients across a heterogenous array of advanced solid tumours.…”

Concurrent <i>de novo</i> Thymoma-associated Paraneoplastic Type 1 Autoimmune Hepatitis and Pure Red Cell Aplasia after Thymectomy: A Case Report and Literature Review

“…We conducted a database (PubMed, National Library of Medicine) searching for publications up until December 2021, with keywords "thymoma" and "autoimmune hepatitis." Including the cur-rent case, only 13 cases of thymoma-associated AIH were identified (Table 2) (7,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). The median age of onset is 35 years (range 25 ˜77 years), with a female preponderance (61.5%, 8/13).…”

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. Escalating doses of pyridostigmine require caution as high doses may worsen weakness due to cholinergic crisis; pyridostigmine may also be arrhythmogenic, and increase bronchial secretions,10 particularly important with coexisting myocarditis.…”