Antibody-mediated pure neutrophil aplasia, recurrent myasthenia gravis and previous thymoma: case report and literature review

Q J Med. 1990 Jan;74(273):57-61.

Abstract

We describe a case of neutrophil aplasia in a woman with recurrent myasthenia gravis and a past history of thymoma. Bone marrow showed virtually absent granulopoiesis but normal erythropoiesis and megakaryopoiesis. Bone marrow cultures showed no growth of granulocyte/mononuclear cell progenitors (CFU-GM). She was treated with immunosuppression including azathioprine, and her neutrophil count returned to normal. Serum before treatment, and also an IgG fraction thereof, inhibited CFU-GM growth both in autologous 'remission' marrow and in allogeneic marrow. She remains in complete remission 36 months after starting azathioprine. This association is extremely rare, and was formerly associated with a grim prognosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Agranulocytosis / complications*
  • Antibodies / immunology
  • Azathioprine / therapeutic use
  • Bone Marrow / pathology
  • Female
  • Humans
  • Immunosuppression Therapy
  • Myasthenia Gravis / complications*
  • Myasthenia Gravis / drug therapy
  • Myasthenia Gravis / immunology
  • Neutropenia / complications*
  • Neutropenia / drug therapy
  • Neutropenia / immunology
  • Neutropenia / pathology
  • Stem Cells / pathology
  • Thymoma / complications*
  • Thymus Neoplasms / complications*

Substances

  • Antibodies
  • Azathioprine