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

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.