Our patients lymphocytopenia, as well as his development of autoimmune symptoms following thymus resection, suggest that our patients thymectomy in conjunction with his radiation therapy, are likely culprits for immunodeficiency, and not his thymoma

Our patients lymphocytopenia, as well as his development of autoimmune symptoms following thymus resection, suggest that our patients thymectomy in conjunction with his radiation therapy, are likely culprits for immunodeficiency, and not his thymoma. Another possible explanation for our patients condition is that he had a pre-existing autoimmune disorder and later developed thymoma. respond to 11 of 12 serotypes of the pneumococcal vaccine. As a result, he was placed on Bactrim? (trimethoprim-sulfamethoxazole) prophylaxis to prevent opportunistic infections, Bioymifi and his CD4+ and CD8+ counts were monitored over the course of 8 years. His lymphocyte counts 87 months after thymectomy and 85 months after radiation therapy were as follows: absolute lymphocyte count 956 cells/mcL, absolute CD3+/CD4+ 164/mm3 (16%) and absolute CD3+/CD8+ 257/mm3 (25%). The patient was able to discontinue Bactrim? (trimethoprim-sulfamethoxazole) prophylaxis after 9 years of treatment. Conclusions The lymphocytopenia, low CD4+ count, Bioymifi and failed response to pneumococcal vaccination that presented in our patient are consistent with immunodeficiency. After radiation alone, a recovery of T-lymphocytes is usually observed after approximately 3 weeks. Over the course of 8 years, he has still not made a full recovery according to laboratory markers, which seem to have stabilized at chronically low levels. To prevent serious complications, we suggest that patients who have undergone both thymectomy and radiation therapy be monitored for immunodeficiency. This case report informs the practices of allergists, oncologists, and neurologists in the continuing care of patients with thymoma. Keywords: Chronic idiopathic urticaria, Immunodeficiency, Lymphocytopenia, Thymectomy, Thymoma Introduction The thymus, an organ composed of lymphoid and epithelial tissue, is located in the anterior superior mediastinum and responsible for the selection and maturation of T-lymphocytes. On the onset of puberty, the thymus begins to involute, shrinking in size throughout adulthood and leading to a profound decline of thymic function LEFTYB by early adulthood. Thymoma, arising from the epithelial cells, is an uncommon tumor of the thymus and is typically treated with surgical excision. Induction and/or adjuvant chemotherapy may be used if the invasion of the tumor infiltrates into surrounding tissue. A commonly used regimen in current practice is cisplatin-based chemotherapy. However, there are no randomized trials that evaluate the effectiveness of chemotherapy for thymic carcinoma or advanced thymoma in adults [1]. Furthermore, the prognosis of patients with totally resected stage III and stage IV thymoma was not improved with adjuvant therapy [2]. Radiation therapy of the mediastinum causes a rapid decrease in circulating B- and T- lymphocytes. While the acute decrease in lymphocytes post-procedure Bioymifi is short lived, most patients show a modest chronic depression in both numbers and function of circulating lymphocytes [3, 4]. CD4+ lymphocyte recovery after dose-intense chemotherapy is constrained in adults both by a limited thymic regenerative capacity, as well as an increased susceptibility to apoptosis within the expanding peripheral CD4+ population [5, 6]. In a study of children and young adults exposed to chemotherapy, the thymopoietic pathway of CD4+ T-lymphocyte regeneration was shown to be important throughout childhood. However, it is unclear whether there is an age after which the thymus loses it regenerative capacity completely [7]. Thymectomy is a common therapeutic option to treat myasthenia gravis (MG), a condition commonly associated with thymoma. In a long-term study of patients who had undergone a thymectomy, laboratory work demonstrated a mild T-cell lymphocytopenia and an expansion of some V-beta families among the circulating CD4+ and CD8+ T cells, as well as organ and non-organ-specific autoantibodies [8]. A more Bioymifi recent study suggested that extrathymic development of T-cells in the tonsils supports the generation of autoreactive T-lymphocytes, and may even contribute to malignant transformation [9]. Extrathymic T-cell development suggests an increase of systemic autoimmune disease secondary to thymectomy in patients with MG [8], possibly explaining the development of systemic lupus erythematosus (SLE) in patients months or years after surgical thymectomy [10]. This Bioymifi discovery assumes an important role in adults who have undergone chemotherapy, accounting for increased autoimmunity in these patients [11, 12]. In this case report, we present a patient who developed a significant, sustained CD4+ lymphocytopenia and chronic idiopathic urticaria after a combination of thymectomy and radiation as treatment for thymoma. Case presentation Over 9 years ago, a 59-year-old Asian man was referred to our office by his primary care physician with a history of extensive daily hives consisting of severe itching for the past 3 to 4 4 months. While his skin rash was aggravated by stress and cold weather, there was no association with any foods or medications. The only unusual aspect of his past medical history was a microinvasive thymoma involving the capsule, which was diagnosed 2 years prior to his appointment at our office. Before treatment of the thymoma, his white cell and absolute lymphocyte counts were within normal limits; however, his CD4+ and CD8+ counts were not measured prior.