Antithymocyte globulin
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Lack of efficacy: case report A 60-year-old woman exhibited lack of efficacy with antithymocyte globulin during treatment for aplastic anaemia. The woman, who was diagnosed with seropositive myasthenia gravis (MG), was initiated on pyridostigmine and prednisolone with good symptom control. Imaging studies confirmed thymoma (T1N0M0), and total thymectomy was scheduled. Radiotherapy was given postoperatively due to the large tumour size and close margins. Her white cell count (WCC) decreased significantly. She received unspecified granulocyte colony stimulating factors. Her WCC had recovered, but immediately decreased again, and she developed pancytopenia. A paroxysmal nocturnal haemoglobinuria clone was noted. There was evidence of concurrent human herpesvirus 7 and parvovirus B19 infection. Bone marrow trephine biopsy and the findings confirmed a diagnosis of aplastic anaemia with decreased cellularity, occasional granulopoiesis and absent erythropoiesis and thrombopoiesis. She started receiving ciclosporin, which had little effect. Afterwards, she received a course of antithymocyte globulin [horse antithymocyte globulin; route and dosage not stated] for aplastic anaemia, which had no impact on WCC. It was concluded that the aplastic anaemia was attributed to the thymectomy procedure. The woman required red cell and platelet transfusions due to persistently low WCC. The symptoms of MG were well controlled. She eventually received an allogenic stem cell transplant (SCT) after a match was found. Unfortunately the transplantation was unsuccessful, and she passed away from complications due to Epstein Barr virus-associated post-transplant lymphoproliferative disorder following the SCT. Franchi T, et al. Aplastic Anemia Secondary to Thymectomy in a Patient With Myasthenia Gravis. Annals of Thoracic Surgery 110: e173-e175, No. 3, Sep 2020. Available from: URL: http://doi.org/10.1016/j.athoracsur.2020.01.044 803503803
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Reactions 26 Sep 2020 No. 1823
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