some hematologic dyscrasias have been associated with thymoma . about 5% of patients with thymoma develop pure red cell aplasia ( prca ) .
other hematologic complications occur far less frequently and include autoimmune hemolytic anemia , pernicious anemia , peripheral neutropenia , agranulocytosis , thrombocytopenia and hypogamma - globulinemia .
prca disappear after thymectomy but reappear after a latency period even without recurrence of thymoma .
aplastic anemia is a rare complication of thymoma and is properly documented in only a few cases .
as thymoma - associated hematologic dyscrasias are likewise supposed to be of immunologic origin , we report here a case of very severe aplastic anemia following thymectomy , which was successfully treated with immunosuppressants such as cyclosporine a and g - csf .
a 60-year - old woman who complained of cough and dyspnea visited the pulmonary department in april 2000 .
chest radiography and computed tomography ( ct ) showed a large mass in the anterior mediastinum , compatible with a thymoma ( figure 1 ) .
about sixteen months after the operation , a non - productive cough and high fever developed .
a routine hematologic feature was as follows ; hb 5.9 g / dl ; hct 16.9% ; wbc 0.810/l , absolute neutrophil count 0.210/l ; platelets 8610/l .
there was no recent antecedent exposure to chemicals and drugs , and serology for hepatitis a , b , c , parvovirus and hiv infection was negative .
cytomegalovirus and epstein - barr virus serology was consistent with previous viral exposure . with a high suspicion of aplastic anemia , multiple bone marrow aspirations and biopsy
histopathological examination of the bone marrow disclosed extremely low marrow cellularity with increased fatty areas .
the patient received transfusions of platelet concentrate and empiric antibiotic therapy for fever and neutropenia during her hospital course .
after her neutropenic fever subsided , oral cyclosporine a ( 5 mg / kg / day ) was administered .
three months after this treatment , she is clinically stable with no transfusion requirement and without any signs of infection .
peripheral blood counts were as follows : hb 10.3 g / dl ; hct 30.2% ; wbc 3.510/l , absolute neutrophil count 1.910/l ; platelets 16410/l .
from then to march , 2002 , the patient remained in complete remission with low doses of cyclosporine alone .
thymoma is the most common tumor of the anterior mediastinum and is often associated with autoimmune diseases , including myasthenia gravis , polymyositis , hypogammaglobulinemia and various cytopenia .
in fact , the overall long - term survival of patients with thymoma is poor once cytopenias occur .
although thymectomy is indicated in thymomas with blood dyscrasia , a permanent hematologic remission can be expected in less than 30% of patients with thymoma - associated prca .
often , the immunoassociated symptoms like prca disappear after thymectomy but reappear after a latency period , even without recurrence of thymoma , and there is no codified therapy for surgically resistant or relapse cases . in aplastic anemia , thymectomy may fail to resolve aplastic cytopenias as in the case presented by liozon et al .
pl et al presented a patient with aplastic cytopenia - associated thymoma in whom complete remission was achieved with surgical removal of the thymoma .
alg and cyclosporin , often successful in primary as well as secondary prca and idiopathic aa , should be proposed in unresponsive cases .
reported that the combination of octreotide and prednisone produced a complete clinical response in a patient with malignant thymoma and pure red cell aplasia .
aplastic anemia is a rare complication of thymoma and is extremely infrequent after thymectomy . in large series ,
the incidence of aa with thymoma is 01.4% to our knowledge , this is the fourth report of aplastic anemia following thymectomy many pathogenetic mechanisms have been suggested to explain the bone marrow failure seen in aplastic anemia .
especially , the role of suppressor t lymphocytes is considered important in the development of aplastic anemia .
similarly , thymoma associated with aplastic anemia seems to be caused by the suppression of the bone marrow due to an unbalanced regulation and the inhibitory effects of t lymphocytes on bfu - e and cfu - e as demonstrated in previous reports . because immune mechanisms appear to play an important part in the maintenance and/or progression of thymoma - associated aplastic anemia , this is the rationale for the use of immunosuppressive therapy as one option in the treatment of the disease .
cyclosporine a has been associated with good responses in cases of thymoma - associated prca and aplastic anemia , so we decided to treat the patient with cyclosporine a and g - csf .
thus , our case seems to be an example for the development of very severe aa , following surgical removal of a thymoma , in which an immunosuppressive agent like cyclosporine a has been efficient .
 aplastic anemia is a rare complication of thymoma and is extremely infrequent after thymectomy . 
 we present a case of a 60-year - old woman with very severe aplastic anemia appearing sixteen months after thymectomy for a thymoma . 
 she underwent thymectomy for a thymoma in april 2000 . 
 preoperative examination revealed no hematologic abnormality . 
 about sixteen months after the operation , she was readmitted because of pancytopenia with cough and fever . 
 bone marrow aspiration revealed a very severe hypoplasia in all the three cell lines with over 80% fatty tissue , and chest ct revealed no recurrence of thymoma . 
 her aplastic anemia had responded to cyclosporine a and granulocyte - colony stimulating factor ( g - csf ) . 
INTRODUCTION
CASE
DISCUSSION