Delayed Presentation of Thymoma-Related Aplastic Anemia: An Unusual Presentation of a Rare Complication

A 68-year-old Caucasian man presented with gross hematuria and oral mucosal bleeding. The patient was known to have an anterior mediastinal mass, highly suspicious for thymoma, which was incidentally identified on imaging, 8 years prior. The patient then declined treatment and was lost to follow-up. On presentation, imaging re-demonstrated the anterior mediastinal mass and the patient was found to have profound pancytopenia. Bone marrow biopsy confirmed the diagnosis of aplastic anemia (AA). Despite optimal treatment, the patient expired on day 9 of admission. In this case we report an unusual presentation of thymoma-related AA (TR-AA), a rare complication of thymoma, presenting years after initial diagnosis in a patient with long standing thymoma that was left untreated as per the patient's wishes. To our best knowledge, this is the first published report where TR-AA presented 8 years after initial diagnosis in a patient with unresected and untreated thymoma.