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Autoimmune Encephalitis Induced by SARS-CoV-2 Infection Treated with Thymectomy.

Cristian Puerta1, Nolan M Winicki1, Casandra E Besse1

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Summary
This summary is machine-generated.

Thymoma patients with autoimmune encephalitis, triggered by SARS-CoV-2, may recover after thymectomy. Surgical removal of the thymus tumor cleared autoantibodies and restored neurological function in a rare case.

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Area of Science:

  • Neurology
  • Immunology
  • Oncology

Background:

  • Thymomas are associated with paraneoplastic autoantibodies targeting neurogenic epitopes like collapsin-response-mediator protein-5 receptor (CRMP-5) and alpha-amino-3-hydroxyl-5methyl-4isoxazolepropionic acid receptor (AMPAR).
  • Autoimmune encephalitis can occur in patients with thymoma, particularly following viral infections such as SARS-CoV-2.

Observation:

  • A patient with thymoma and myasthenia gravis developed coma due to autoimmune encephalitis after SARS-CoV-2 infection.
  • Standard treatments including plasmapheresis, high-dose steroids, pyridostigmine, eculizumab, and rituximab failed to improve the patient's neurological status.

Findings:

  • Robotic thymectomy and thymoma resection led to undetectable levels of CRMP-5 and AMPAR antibodies.
  • The patient experienced a full neurological recovery following the thymectomy.

Implications:

  • Thymectomy is a potential curative treatment for autoimmune encephalitis in patients with thymoma.
  • Thoracic surgeons must be aware of this rare but treatable condition.
  • This case highlights the link between thymoma, autoimmunity, and neurological dysfunction, emphasizing the importance of considering thymectomy in refractory cases.