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Goto T, Kogure A, Kuwano Y. Photochemotherapy for thymoma-associated graft-versus-host disease-like eruptions. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:181-183. [PMID: 34585776 DOI: 10.1111/phpp.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Taeko Goto
- Department of Dermatology, Showa General Hospital, Kodaira, Japan
| | - Asako Kogure
- Department of Dermatology, Showa General Hospital, Kodaira, Japan
| | - Yoshihiro Kuwano
- Department of Dermatology, Showa General Hospital, Kodaira, Japan
- Department of Dermatology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan
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Bendayan S, Mititelu R, Elizabeth Redpath M, Billick R. Thymoma-associated multiorgan autoimmunity with cutaneous only presentation: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211055928. [PMID: 34733517 PMCID: PMC8558791 DOI: 10.1177/2050313x211055928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Thymoma-associated multiorgan autoimmunity disease can be seen in patients with thymomas and presents with features of graft versus host disease. Here, we report a case of a 52-year-old woman with a complex medical history including malignant thymoma, myasthenia gravis, Good’s syndrome, and T cell large granular lymphocytic leukemia who presented with a diffuse pruritic rash ultimately found to be compatible with a cutaneous presentation of thymoma-associated multiorgan autoimmunity disease. The eruption heralded the recurrence of the malignant thymoma and the rash was ultimately found to be resistant to a multitude of therapies except for oral corticosteroids.
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Affiliation(s)
| | - Roxana Mititelu
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Robin Billick
- Division of Dermatology, Jewish General Hospital, Montreal, QC, Canada
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3
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Wheat CM, Gami A, Doong JC, Zampella JG, Loss M. Thymoma-associated multiorgan autoimmunity treated with multimodal therapy including extracorporeal photopheresis. JAAD Case Rep 2021; 16:141-143. [PMID: 34621938 PMCID: PMC8484729 DOI: 10.1016/j.jdcr.2021.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chikoti M Wheat
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Abhishek Gami
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Judy C Doong
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John G Zampella
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Manisha Loss
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
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4
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Lau YM, Trendell-Smith NJ, Yeung CK, Wong SM, Chan HLH, Chan WMM. Graft-versus-host-disease-like disease in a patient with thymic lipomatosis. J Dermatol 2021; 48:e458-e459. [PMID: 34265106 DOI: 10.1111/1346-8138.16011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Yuk-Ming Lau
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | | | - Chi-Keung Yeung
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sze-Man Wong
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hin-Lee Henry Chan
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wai-Man Mandy Chan
- Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Wrona E, Dębska-Szmich S, Pastuszka M, Braun M, Czyżykowski R, Potemski P. Remission of Thymoma on Steroid Therapy in a Patient With Atypical Thymoma-Associated Multiorgan Autoimmunity: A Case Report and Literature Review. Front Immunol 2021; 12:584703. [PMID: 33995340 PMCID: PMC8116704 DOI: 10.3389/fimmu.2021.584703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/12/2021] [Indexed: 01/31/2023] Open
Abstract
In up to 34% of cases, thymoma, itself a rare neoplasm, is accompanied by autoimmune disorders, two of which are thymoma-associated multiorgan autoimmunity (TAMA) and paraneoplastic autoimmune multiorgan syndrome (PAMS). Unfortunately, differential diagnosis between these two entities can be challenging since no strict PAMS definition exists and PAMS can overlap with a subgroup of TAMA patients with skin lesions as leading presentation. We present a case of a 68-year-old woman with a diagnosis of thymoma accompanied by myasthenia gravis, hypothyroidism and GvHD-like mucocutaneous lesions that initially could account to both TAMA and PAMS diagnosis. However, following the exclusion of humoral autoimmunity against components of epithelial cells junction, TAMA was finally established. Interestingly, the introduction of corticosteroid therapy for TAMA symptom management resulted in unexpected partial remission of thymoma with no impact on mucocutaneous lesions. Our case study is an example of two extremely rare phenomena accompanying thymomas: unprecedented TAMA presentation with GvHD-like mucositis, which as we postulate should be placed in the spectrum of TAMA, and tumor remission on steroids.
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Affiliation(s)
- Ewa Wrona
- Department of Chemotherapy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Sylwia Dębska-Szmich
- Department of Chemotherapy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Marta Pastuszka
- Department of Dermatology, Medical University of Lodz, Lodz, Poland
| | - Marcin Braun
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland
| | - Rafał Czyżykowski
- Department of Chemotherapy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Piotr Potemski
- Department of Chemotherapy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, Lodz, Poland
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Hile GA, Novice T, Kochkodan J, Chan MP, Gudjonsson JE, Eshaq M. Thymoma-associated multiorgan autoimmunity initially manifested by graft-versus-host disease-like erythroderma: Case report and possible therapeutic role of antimalarial drugs. JAAD Case Rep 2020; 6:719-721. [PMID: 32715060 PMCID: PMC7369524 DOI: 10.1016/j.jdcr.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Grace A Hile
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Taylor Novice
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - May P Chan
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Milad Eshaq
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
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Solimani F, Maglie R, Pollmann R, Schmidt T, Schmidt A, Ishii N, Tackenberg B, Kirschbaum A, Didona D, Pickert J, Eming R, Hashimoto T, Hertl M. Thymoma-Associated Paraneoplastic Autoimmune Multiorgan Syndrome-From Pemphigus to Lichenoid Dermatitis. Front Immunol 2019; 10:1413. [PMID: 31293579 PMCID: PMC6598597 DOI: 10.3389/fimmu.2019.01413] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/04/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction: Paraneoplastic autoimmune multi-organ syndrome (PAMS) is a rare clinical condition characterized by variable and heterogeneous clinical phenotypes in the presence of neoplasias which largely depend on the activation of humoral and cellular immune responses. Clinically, these patients present with a spectrum of antibody-driven pemphigus-like lesions to graft-vs.-host-disease-like exanthemas with a lichenoid inflammatory infiltrate in the skin. PAMS is occasionally associated with thymoma, in which altered immune surveillance eventually leads to multiorgan autoimmunity which often includes variable cutaneous symptoms. This disorder is associated with a profound disturbance of peripheral immune tolerance against human autoantigens. Objectives: We here present a patient with relapsing thymoma who developed PAMS with several cutaneous and extracutaneous autoimmune disorders. Materials: Peripheral blood mononuclear cells (PBMC), sera, and lesional skin biopsies were obtained at different clinical disease stages. Peripheral T cell subsets were characterized phenotypically and the cytokine profile of the peripheral blood T cellular response against distinct epidermal and dermal autoantigens of the skin was analyzed by ELISpot assay. Serological screening was performed by ELISA and immunoblot analysis. Skin biopsies were subjected to immunohistochemical analysis of distinct T cell subsets. Thymoma tissue was analyzed for the presence of T regulatory cells and compared with adult thymus and indolent thymoma. Results and Conclusions: In the present case, thymoma was the cause of the observed multi-organ autoimmune syndromes as its recurrence and surgical removal was associated with the relapse and regression of the cutaneous symptoms, respectively. Initially, the patient presented with two autoimmune disorders with Th2/Th1 imbalance, myasthenia gravis (MG) and pemphigus foliaceus (PF), which regressed upon immunosuppressive treatment. Months later, the patient developed a lichenoid exanthema with a Th1-dominated skin infiltrate. Further clinical evaluation revealed the recurrence of the thymoma and the lichenoid exanthema gradually regressed upon thymectomy. Our contention that T cell recognition against distinct cutaneous autoantigens, such as desmoglein 1 (Dsg1), shifted from a Th2 to a Th1-dominated immune response could not be fully substantiated as the patient was on a stringent immunosuppressive treatment regimen. We could only observe a decrease of the initially present serum IgG autoantibodies against Dsg1. Phenotypic analysis of the associated thymoma showed a lower number of T regulatory cells compared to adult thymus and indolent thymoma, suggesting that impaired thymus-derived immune surveillance had a direct impact on the outcome of the observed cutaneous autoimmune disorders.
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Roberto Maglie
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Robert Pollmann
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Thomas Schmidt
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Ansgar Schmidt
- Institute of Pathology, Philipps-University, Marburg, Germany
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Björn Tackenberg
- Department of Neuroimmunology, Philipps-University, Marburg, Germany
| | | | - Dario Didona
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Julia Pickert
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - Takashi Hashimoto
- Department of Surgery, Philipps-University, Marburg, Germany
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
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