Thymoma associated with severe pancytopenia and Good's syndrome: case report

We report a rare case of thymoma associated with pancytopenia and Good's syndrome. The patient was a previously healthy 60-year-old female who presented to the emergency department with a severe headache. Her initial work up was significant for a parenchymal hemorrhage and severe pancytopenia. A CAT scan of her chest, abdomen, and pelvis demonstrated a large mediastinal mass and core biopsy confirmed thymoma. Bone marrow aspirate was hypocellular. Initial multidisciplinary discussion recommended immunosuppressive therapy to treat her aplastic anemia prior to resection. However, she remained transfusion-dependent from her pancytopenia and required prolonged admission. Ultimately, the patient was unable to undergo immunosuppressive therapy due to persistent infection. Hematology/oncology believed that the initial response to immunosuppressive therapy would further compromise her immune function and would be detrimental for the patient. After undergoing thymectomy, she suffered from persistent severe pancytopenia, diarrhea, and pneumonia. She remained transfusion-dependent and despite remaining on broad spectrum antimicrobials, she continued to have fevers. She was diagnosed with Good's syndrome postoperatively after she was found to be hypogammaglobulinemic. She received intravenous immunoglobulin (IVIG) immediately, but ultimately expired from multi-system organ failure. This case report highlights the importance of early diagnosis and multidisciplinary treatment for patients who have hypogammaglobulinemia, severe pancytopenia, and thymoma. We recommend early treatment of IVIG.