Subclinical cardiac involvement in thymomatous Myasthenia Gravis

A 58-year-old man presented with a two-month history of eyelid ptosis and fatigue, emerging two months after thymectomy for an incidentally detected thymoma. Histological examination revealed type AB (spindle/oval-shaped neoplastic epithelial cells lacking nuclear atypia mixed with lymphocyte-rich foci) and IIA (macroscopic invasion into surrounding fatty tissue of mediastinal pleura) pathology according to the WHO and Masaoka classifications, respectively. Clinical examination revealed bilateral eyelid ptosis and weakness of the orbicularis oculi, upper and lower limbs and neck extensor muscles. The electrophysiological study showed disorder of the neuromuscular junction, and the serum acetylcholine receptor antibodies were positive with a titer of 46 nM (positive titer >0.6 nM). Pyridostigmine resulted in mild clinical improvement. A thorough cardiac evaluation was performed, including an