Thymoma and Myasthenia Gravis in a patient with Sarcoidosis

Coexistence of thymoma, myasthenia gravis (MG) and sarcoidosis is very rare. To the best of our knowledge, thymoma, MG and sarcoidosis has not been reported together in the literature. We report an interesting case with coexisting thymoma, MG and sarcoidosis. A 59 year old female patient with a history of sarcoidosis, was admitted to the hospital with a one‐day history of sudden onset of right sided partial ptosis and diplopia. Neurosarcoidosis with cranial nerve involvement was considered, but was ruled out by the clinical findings, and MG was confirmed by the positive tensilon test, electrophysiological findings and positive Acetylcholine receptor binding antibodies. On further evaluation, CT chest showed left anterior mediastinal mass and bilateral lymphadenopathy. Post surgical diagnosis confirmed the thymoma and sarcoidosis in the lymphnodes. When two or more diseases of undetermined origin are found together, several interesting questions are raised. It is important to first confirm the diagnoses individually. Immunologic mechanisms triggering the occurrence of these diagnoses together, is difficult to address. Although the coexistence of thymoma, MG and sarcoidosis may be coincidental, it is noteworthy to report this case because of the multiple interesting features observed as well as the rarity of occurrence.