Recurrent thymoma-associated PRCA with persistent agranulocytosis: a case report and therapeutic considerations

We report a case of recurrent type A thymoma accompanied by pure red cell aplasia (PRCA) and agranulocytosis. Following local recurrence after thymoma resection, the patient gradually developed anemia and leukopenia as the lesion progressed; bone marrow examination showed marked suppression of erythropoiesis and reduced granulopoiesis. Taken together with the peripheral blood findings, these results suggested thymoma-associated immune-mediated hematopoietic injury. Following multidisciplinary evaluation, the patient underwent thoracoscopic resection of the recurrent lesion, and pathological examination confirmed type A thymoma with negative surgical margins. Postoperative follow-up showed gradual recovery of erythropoiesis and achievement of transfusion independence, whereas agranulocytosis persisted; only after regular cyclosporine A treatment and increased drug exposure did the white blood cell and neutrophil counts gradually rise. Based on this case and previous studies, thymoma resection may reduce immune attack on the bone marrow and create conditions favorable for hematopoietic recovery by removing the source of continued generation and export of abnormal T cells; however, abnormal T cells that have already entered the peripheral blood or bone marrow and continue to survive may perpetuate immune-mediated injury. Therefore, blood counts should be monitored serially after surgery, and standardized adjunctive immunosuppressive therapy should be instituted when necessary. During treatment, close attention should also be paid to medication adherence, therapeutic drug concentrations, and monitoring of hepatic and renal function to balance efficacy and safety.