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无重症肌无力的侵袭性胸腺瘤患者的味觉障碍:一例罕见病例报告

Taste disorder in a patient with invasive thymoma without myasthenia gravis: a rare case report.

作者信息

Kosaka Takayuki, Nakahashi Hirotaka, Nakazawa Seshiru, Ibe Takashi, Yajima Toshiki, Shirabe Ken

机构信息

Department of Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan.

Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.

出版信息

Mediastinum. 2022 Mar 25;6:9. doi: 10.21037/med-21-28. eCollection 2022.

Abstract

Taste disorder has been reported as a non-motor symptom caused by myasthenia gravis (MG)-related autoimmune mechanism. Taste disorder in some cases recovered along with MG treatment, such as thymothymectomy or immunosuppressive treatment. However, symptom of taste disorder in thymoma patients without MG is very rare. Here, we reported a case of invasive thymoma without MG which had concurrent taste disorder. The taste disorder was successfully treated with cyclosporine. A female in her seventies had an anterior mediastinal tumor of 78-mm in diameter and pleural dissemination. She also had taste disorder, limited to sweet taste, and pure red cell aplasia (PRCA). Symptoms and physical findings showed no feature of MG. Pre-operative blood examination revealed no elevation of anti-acetylcholine receptor antibody . Extended total thymothymectomy and resection of all detectable pleural disseminations was performed. Pathological examination showed type B3 thymoma. Clinical stage was Masaoka stage IVa. After operation, there was no improvement in taste disorder and PRCA. Six months after operation, cyclosporine was administered for PRCA. In parallel with gradual improvement of anemia, taste disorder also gradually improved. Three months after the first administration of cyclosporine, taste disorder had completely recovered. This is the first case of taste disorder without any myasthenic status, which recovered with immunosuppressive drug. Our case suggested the potency of immunosuppressive treatment for taste disorder associate with thymoma without MG.

摘要

味觉障碍已被报道为一种由重症肌无力(MG)相关自身免疫机制引起的非运动症状。在某些情况下,味觉障碍会随着MG治疗而恢复,如胸腺切除术或免疫抑制治疗。然而,无MG的胸腺瘤患者出现味觉障碍症状的情况非常罕见。在此,我们报告一例无MG的侵袭性胸腺瘤并发味觉障碍的病例。该味觉障碍通过环孢素治疗成功治愈。一名70多岁的女性患有直径78毫米的前纵隔肿瘤并伴有胸膜播散。她还患有味觉障碍,仅限于甜味觉,以及纯红细胞再生障碍(PRCA)。症状和体格检查未显示MG的特征。术前血液检查显示抗乙酰胆碱受体抗体未升高。实施了扩大全胸腺切除术及切除所有可检测到的胸膜播散灶。病理检查显示为B3型胸腺瘤。临床分期为Masaoka IVa期。术后,味觉障碍和PRCA均无改善。术后6个月,给予环孢素治疗PRCA。随着贫血逐渐改善,味觉障碍也逐渐改善。首次给予环孢素3个月后,味觉障碍完全恢复。这是首例无任何肌无力状态的味觉障碍病例,通过免疫抑制药物治愈。我们的病例提示免疫抑制治疗对无MG的胸腺瘤相关味觉障碍有效。

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