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J Thorac Cardiovasc Surg 2006;131:494-495
© 2006 The American Association for Thoracic Surgery

Brief Communication

Fatal giant cell myocarditis after thymoma resection in myasthenia gravis

Thomas M. Joudinaud, MD, PhD, Elie Fadel, MD, PhD * , Vincent Thomas-de-Montpreville, MD, Sacha Mussot, MD, Erwan M. Flecher, MD, Phillippe G. Dartevelle, MD

Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.

Received for publication September 4, 2005; accepted for publication September 28, 2005.

* Address for reprints: Elie Fadel, MD, Laboratoire de Chirurgie Expérimentale, Hôpital Marie-Lannelongue, 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France (Email: efadel@free.fr).

The first 20% of the full text of this article appears below.

Myasthenia gravis (MG) results in weakness and fatigability of skeletal muscles caused by an autoimmune-antibody reaction against acetylcholine receptors at the neuromuscular junction. Treatment includes anticholinesterase agents, thymectomy, and immunosuppression. Surgical thymectomy can induce remission or improvement, allowing for reduction in immunosuppressive treatment. 1 Go Although myocardial dysfunction is usually minimal in MG, thymoma can be associated with severe myocardial failure. 2 Go We report a rare case of fatal giant cell myocarditis (GCM) after a thymoma resection in MG.

Clinical Summary

A 43-year-old man with no previous medical history was given a diagnosis of MG. Thoracic computed tomographic scanning revealed an anterior mediastinal tumor without superior vena caval invasion on venography. Complete resection was performed through a median sternotomy with resection of the anterior pericardium, sparing both phrenic nerves. Histologic analysis revealed an encapsulated thymoma extending in mediastinal fat. The patient was discharged on day 5 after an uneventful recovery. One week later, after a short episode of fever and diarrhea, . . . [Full Text of this Article]




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