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Intestinal pseudo-obstruction as initial presentation of thymoma
C P Musthafa1, Ahsan Moosa, P A Chandrashekharan
1Department of Gastroenterology, Amrita Institute of Medical Sciences, Amrita Lane, Elamakkara P O, Cochin 682 026, India. musthafacpdr@gmail.com
Summary
A thymoma in a 45-year-old man caused severe autonomic dysfunction and gastrointestinal issues. Surgical removal resolved most symptoms, but myasthenia gravis developed later, confirming a paraneoplastic syndrome.
Area of Science:
- Neurology
- Oncology
Background:
- Paraneoplastic syndromes can manifest with diverse neurological symptoms.
- Thymoma is a known cause of paraneoplastic neurological disorders.
Observation:
- A 45-year-old man presented with severe vomiting, constipation, abdominal distention, and bilateral ocular abductor palsy.
- Clinical evaluation revealed diffuse autonomic dysfunction including intestinal pseudo-obstruction, xerophthalmia, xerostomia, postural hypotension, erectile dysfunction, and loss of sinus arrhythmia.
Findings:
- Paraneoplastic work-up identified a thymoma.
- Surgical resection of the thymoma led to significant symptom resolution.
- Worsening external ophthalmoparesis with ptosis developed six weeks post-surgery, responding to acetylcholinesterase inhibitors, confirming myasthenia gravis.
Implications:
- This case highlights the complex neurological manifestations of thymoma-associated paraneoplastic syndromes.
- Early identification and management of thymoma are crucial for improving patient outcomes.
- The development of myasthenia gravis post-thymoma resection underscores the importance of continued neurological monitoring.
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