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Case Report/Case Series |

Acquired Neuromyotonia Heralding Recurrent Thymoma in Myasthenia Gravis

Jori Fleisher, MD1; Megan Richie, MD1; Raymond Price, MD1; Steven Scherer, MD, PhD1; Josep Dalmau, MD, PhD1,2; Eric Lancaster, MD, PhD1
[+] Author Affiliations
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia
2Institució Catalana de Recerca i Estudis Avançats–Institut d’Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Spain
JAMA Neurol. 2013;70(10):1311-1314. doi:10.1001/jamaneurol.2013.2863.
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Importance  Acquired neuromyotonia is increasingly recognized as an autoimmune disorder, frequently associated with antibodies against voltage-gated potassium channel complex proteins. We present a case of acquired neuromyotonia as the heralding symptom of recurrent thymoma in a patient with myasthenia gravis.

Observations  A report of a single case of a 53-year-old man with myasthenia gravis and a prior thymectomy presenting with 2 months of diffuse, involuntary muscle twitching in the absence of myasthenic symptoms, electrophysiologically confirmed to be neuromyotonia. Further evaluation revealed the recurrence of malignant thymoma, accompanied by refractory arrhythmia. Serologic and cerebrospinal fluid testing confirmed the presence of antibodies directed against 2 voltage-gated potassium channel–associated proteins: LGI1 and Caspr2.

Conclusions and Relevance  This case highlights the overlap of myasthenia, neuromyotonia, and thymoma, emphasizing the importance of appropriate tumor screening in the presence of either of the former 2 conditions.

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Figure.
Computed Tomographic Scan of the Chest Revealing Recurrent Thymoma

A 12 × 4.5 × 17-cm lobulated mass of soft tissue is revealed in the dependent aspect of the left hemithorax, abutting the pleura. A biopsy confirmed the mass to be recurrent thymoma.

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