Intestinal failure from thymoma-associated autoimmune enteropathy: a rare case report

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Autoimmune enteropathy presents with gastrointestinal symptoms like altered bowel habits, early satiety, anorexia, and weight loss.
• Malignant thymoma is a rare tumor originating in the thymus gland.
• Metastatic thymoma can present with extrathoracic manifestations, complicating diagnosis and treatment.

Purpose of the Study:

• To report a rare case of metastatic thymoma presenting as autoimmune enteropathy.
• To highlight the diagnostic challenges and poor prognosis associated with this rare clinical presentation.
• To underscore the importance of comprehensive investigations in unexplained gastrointestinal failure.

Main Methods:

• Case report describing a patient with unexplained gastrointestinal symptoms.
• Diagnostic procedures included upper gastrointestinal endoscopy and ileocolonoscopy with biopsies.
• Further investigations involved imaging to detect metastatic disease.

Main Results:

• Diagnosis of autoimmune enteropathy confirmed by biopsies.
• Metastatic thymoma identified with pulmonary nodules.
• Patient showed no histological remission or nutritional improvement despite budesonide, mesalazine, and nutritional support, including parenteral nutrition.

Conclusions:

• Metastatic thymoma can manifest as autoimmune enteropathy, leading to intestinal failure.
• This rare presentation carries a poor prognosis, as illustrated by the patient's death.
• Early and accurate diagnosis of both the autoimmune enteropathy and the underlying malignancy is crucial, though challenging.