Abstract
A 54-year-old woman suffering from myasthenia gravis for four years was transferred to the orthopedic section on June 10 1986 because of backache of six months' duration and development of paraplegia. On X-ray examinations including CTs, it was revealed that the seventh thoracic vertebra was collapsed togehter with paravertebral shadows. Thymoma was also noted in the anterior mediastinum. She had been treated with corticosteroid hormone for myasthenic disease till about six months before her admission. Diagnosis was made as paraplegia due to tuberculous spondylitis (Pott's paraplegia) and myasthenia gravis associated with thymoma.
After thymectomy via transsternal approach was done on September 3 1986 and myasthenic symptoms decreased, anterior decompression of the spinal cord followed by interbody fusion from the 6th to the 8th thoracic vertebrae through an extrapleural dissection was done on October 14 1986. Myasthenic crisis occurred on the fourth postoperative day, it was chiefly due to intramuscular injections of streptomycin.
Recovery from paraplegia was good and she could walk with minimal support six months postoperatively but myasthenic symptoms such as upper arm weakness, difficulty in swallowing became worse. Antiacetylcholine-receptor antibody titer was measured up to 400 nanomols per liter (normal:>0.6) 14 months postoperatively. On reexamination of the CTs, there was no evidence of recurrence of thymoma. So immunosuppressant therapy consisting of intravenous cyclophosphamide, adriacin and vincristine and high doses of oral prednisolone was done at intervals of every three weeks starting on December 22 1987 and showed some degree of improvement. She died suddenly on February 14 1988 probably due to acute heart failure.
It might be considered that it was better to use plasmapheresis or hemodyalysis instead of immunosuppressant drugs.
