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Prolonged severe immunodeficiency following thymectomy and radiation: a case report.

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Citation: J Med Case Reports. 8:457, 2014.Journal of Medical Case Reports [Electronic Resource]. 8:457, 2014.PMID: 25528459Institution: MedStar Union Memorial HospitalForm of publication: Journal ArticleMedline article type(s): Case Reports | Journal ArticleSubject headings: *Immunologic Deficiency Syndromes/dt [Drug Therapy] | *Immunologic Deficiency Syndromes/im [Immunology] | *Thymoma/rt [Radiotherapy] | *Thymoma/su [Surgery] | *Thymus Neoplasms/rt [Radiotherapy] | *Thymus Neoplasms/su [Surgery] | Anti-Infective Agents/tu [Therapeutic Use] | Humans | Immunoglobulins/im [Immunology] | Lymphocyte Count | Male | Middle Aged | Thymectomy | Thymoma/im [Immunology] | Thymus Neoplasms/im [Immunology] | Trimethoprim, Sulfamethoxazole Drug Combination/tu [Therapeutic Use]Year: 2014 Local holdings: Available online through MWHC library: 2007 - presentISSN:

1752-1947

Name of journal: Journal of medical case reportsAbstract: CASE PRESENTATION: We describe the longitudinal progress of a 59-year-old Asian male who underwent thymectomy followed by radiation therapy and subsequently presented with generalized urticaria. Revelation of a low absolute lymphocyte count (615 cells/mcL) on initial evaluation prompted further analysis of his immunoglobulin levels and antigen response to a polysaccharide pneumococcal vaccine (PneumoVax-23). Although his immunoglobulin levels were unremarkable, he failed to respond to 11 of 12 serotypes of the pneumococcal vaccine. As a result, he was placed on Bactrim (trimethoprim-sulfamethoxazole) prophylaxis to prevent opportunistic infections, and his CD4+ and CD8+ counts were monitored over the course of 8 years. His lymphocyte counts 87 months after thymectomy and 85 months after radiation therapy were as follows: absolute lymphocyte count 956 cells/mcL, absolute CD3+/CD4+ 164/mm3 (16%) and absolute CD3+/CD8+ 257/mm3 (25%). The patient was able to discontinue Bactrim (trimethoprim-sulfamethoxazole) prophylaxis after 9 years of treatment.CONCLUSIONS: The lymphocytopenia, low CD4+ count, and failed response to pneumococcal vaccination that presented in our patient are consistent with immunodeficiency. After radiation alone, a recovery of T-lymphocytes is usually observed after approximately 3 weeks. Over the course of 8 years, he has still not made a full recovery according to laboratory markers, which seem to have stabilized at chronically low levels. To prevent serious complications, we suggest that patients who have undergone both thymectomy and radiation therapy be monitored for immunodeficiency. This case report informs the practices of allergists, oncologists, and neurologists in the continuing care of patients with thymoma.INTRODUCTION: Immunodeficiency can occur both in patients undergoing radiation therapy, as well as in patients who have had thymectomies. However, few studies have examined the immune recovery of a patient following both procedures. We aim to emphasize the need for assessment and consistent monitoring of patients with thymoma prior to and after combined treatment of thymectomy and radiation, both of which are likely to result in an increased risk for immunodeficiency.All authors: Sekhsaria S, Wickemeyer JLFiscal year: FY2015Digital Object Identifier:

http://dx.doi.org/10.1186/1752-1947-8-457

Date added to catalog: 2016-07-15

Holdings ( 1 )
Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	25528459	Available		25528459

Available online through MWHC library: 2007 - present

CASE PRESENTATION: We describe the longitudinal progress of a 59-year-old Asian male who underwent thymectomy followed by radiation therapy and subsequently presented with generalized urticaria. Revelation of a low absolute lymphocyte count (615 cells/mcL) on initial evaluation prompted further analysis of his immunoglobulin levels and antigen response to a polysaccharide pneumococcal vaccine (PneumoVax-23). Although his immunoglobulin levels were unremarkable, he failed to respond to 11 of 12 serotypes of the pneumococcal vaccine. As a result, he was placed on Bactrim (trimethoprim-sulfamethoxazole) prophylaxis to prevent opportunistic infections, and his CD4+ and CD8+ counts were monitored over the course of 8 years. His lymphocyte counts 87 months after thymectomy and 85 months after radiation therapy were as follows: absolute lymphocyte count 956 cells/mcL, absolute CD3+/CD4+ 164/mm3 (16%) and absolute CD3+/CD8+ 257/mm3 (25%). The patient was able to discontinue Bactrim (trimethoprim-sulfamethoxazole) prophylaxis after 9 years of treatment.

CONCLUSIONS: The lymphocytopenia, low CD4+ count, and failed response to pneumococcal vaccination that presented in our patient are consistent with immunodeficiency. After radiation alone, a recovery of T-lymphocytes is usually observed after approximately 3 weeks. Over the course of 8 years, he has still not made a full recovery according to laboratory markers, which seem to have stabilized at chronically low levels. To prevent serious complications, we suggest that patients who have undergone both thymectomy and radiation therapy be monitored for immunodeficiency. This case report informs the practices of allergists, oncologists, and neurologists in the continuing care of patients with thymoma.

INTRODUCTION: Immunodeficiency can occur both in patients undergoing radiation therapy, as well as in patients who have had thymectomies. However, few studies have examined the immune recovery of a patient following both procedures. We aim to emphasize the need for assessment and consistent monitoring of patients with thymoma prior to and after combined treatment of thymectomy and radiation, both of which are likely to result in an increased risk for immunodeficiency.

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