Thoracoscopic extended thymothymectomy for myasthenia gravis with aplastic anemia

It is very rare for both myasthenia gravis and aplastic anemia to be complicated with a thymoma. A 74-year-old female was diagnosed to have aplastic anemia with pancytopenia and systemic myasthenia gravis with severe restrictive respiratory dysfunction. Chest CT showed a 5-cm diameter thymoma. After platelets and packed red blood cells were transfused before surgery, an extended thymothymectomy was performed with a bilateral thoracoscopic approach. The thymoma was noninvasive, stage I, and was classified as B1 according to the World Health Organization classification. After the operation, the patient was managed on artificial ventilation with no complications. The myasthenia gravis remitted with the concomitant administration of steroids and immunosuppresants, but the aplastic anemia was not ameliorated. A thoracoscopic thymothymectomy for such a high-risk case of infection and respiratory distress is appropriate surgical procedure, but the complications associated with aplastic anemia are intractable.