Pure red cell aplasia with thymoma maintaining remission without treatment after cyclosporine therapy and thymomectomy: Report of a case

Abstract

A 62-year-old man visited our emergency room for dyspnea. The blood hemoglobin level was 4.1 g/dL. Bone marrow examination showed only hypoplasia of erythroblasts. Chest computed tomography revealed a nodular shadow in the right upper lobe of the lung and a mass shadow in the anterior mediastinum. He was diagnosed with pure red cell aplasia with thymoma, and underwent video-assisted thoracoscopic thymomectomy and partial lung resection. Pathological examination showed a type AB thymoma and pulmonary hamartoma. We introduced cyclosporine eight days after the operation. Complete remission of pure red cell aplasia was obtained after gradual reduction of cyclosporine, and the administration of cyclosporine was ceased one year and four months after surgery. The remission of pure red cell aplasia was maintained and the thymoma had not recurred at five years after surgery. In general, the effect of a thymomectomy on pure red cell aplasia with a thymoma is poor, while cyclosporine is highly effective for the induction and maintenance of pure red cell aplasia. Our case is rare in maintaining remission of pure red cell aplasia after stopping cyclosporine and showing the contribution of thymomectomy.