Induction chemotherapy with carboplatin and paclitaxel for thymoma in acute respiratory distress due to myasthenia gravis: a case report

Background: Myasthenia gravis (MG) is presented in 30-50% of thymoma cases, particularly in AB, B1 and B2 thymomas, and often associated with antibodies against acetylcholine receptor (AChR). Symptoms include muscle weakness and fatigue, and the severity depends on the muscles involved. Surgery is recommended in resectable thymomas, and after induction chemotherapy in locally advanced cases. The occurrence of acute respiratory insufficiency is a rare but potentially life-threatening event and may preclude the possibility to perform an adequate induction systemic treatment in resectable patients.Case Presentation: We herein describe a case of a patient who underwent induction chemotherapy with carboplatin and paclitaxel for stage IVa thymoma while on ventilator support for respiratory insufficiency due to MG; the remarkable radiological response and the marked improvement in neurological symptoms made it possible to discontinue ventilatory support and carry out surgery with subsequent complete tumor resection. Unfortunately, due to an infection of the surgical wound, it was not possible to complete the therapeutic process with adjuvant radiotherapy.Conclusions: Initiation of chemotherapy induction treatment in a patient on mechanical ventilation because of acute MG is a challenge, but this should not hold back from starting a treatment, if it is considered potentially curative. The recommended induction chemotherapy regimen is the combination of doxorubicin, cisplatin, and cyclophosphamide, but in selected cases non-anthracyline regimens may be chosen. Whenever feasible, a multimodal approach including chemotherapy surgery and radiotherapy should be preferred.