Granulocytic Leukemia Associated with Myxedema Thyroiditis and Myasthenia Gravis

Abstract

A case of myxedema associated with Hashimoto's thyroiditis, myasthenia gravis, and granulocytic leukemia is described. The patient had the classical symptoms and signs of hypothyroidism. Profound myopathy, ptosis, and bulbar signs suggested myasthenia gravis and the diagnosis was confirmed by an anticholinesterase test. Treatment with cholinesterase inhibitors was ineffective and ACTH was given for increasing bulbar signs and ventilatory failure. Severe pneumonia supervened and was thought t o be the cause of a striking leukemoid blood picture. However, the leukemoid picture persisted after the pneumonia cleared. While convalescing, the patient died suddenly. At autopsy, granulocytic infiltrates of several organs and a hypercellular bone marrow with a preponderance of granulocytes, a decrease in erythrocytic elements and virtual absence of megakaryocytes were consistent with a diagnosis of granulocytic leukemia. The thyroid disease and the myasthenia gravis may have had an immunological basis and this may also have played a role in the development of the granulocytic leukemia.The association of myasthenia gravis, thyroid disease and certain other auto-immune disorders is well known. This report describes a patient who demonstrated the myxedema of Hashimo to's thyroiditis, myasthenia gravis and granulocytic leukemia. CASE REPORTN.D. was a 50-year-old married white male machinist. He was admitted to Hines Veterans

Association between Myasthenia Gravis and Malignant Lymphoma

“…In reviewing the literature we found 5 additional reports of lympho mas associated with MG [5,7,26,[28][29][30]. The case of reticulum cell sarcoma in a myasthenic patient reported here increases to 10 the total number of lymphoreticular malignancies reported in these patients.…”

“…It is mainly responsible for cellular immunity but has a definite effect on humoral immunity as well [10,11,13,25,34], Abnormal function of the thymus may cause immune deficiency states or cellular-humoral im munologic imbalance. These conditions are thought to influence the ap pearance of both malignancy and autoimmune diseases [8,10,12,23,[30][31][32], G atti and G ood [8| demonstrated that the occurrence of malig nancy, especially of the lymphoreticular system, is 10,000 times higher in patients with immune deficiency than in an age and sex-matched con trol group. Lymphomas occur in a very high rate in patients with renal transplants while on immunosuppressive therapy [12].…”