Thymoma-Induced Severe Biventricular Failure without Myasthenia Gravis: Investigating Tachycardia-Induced Cardiomyopathy.

Lim, R; Wiltshire, S; Barnet, M; Low, JP; Bolitho, S; Kane, A; Jabbour, A; Kotlyar, E; Hayward, C

Thymoma-Induced Severe Biventricular Failure without Myasthenia Gravis: Investigating Tachycardia-Induced Cardiomyopathy.

Lim, R Wiltshire, S Barnet, M Low, JP Bolitho, S Kane, A Jabbour, A Kotlyar, E Hayward, C

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Publisher:: International Scientific Information
Publication Type:: Journal Article
Citation:: Am J Case Rep, 2025, 26, pp. e945796
Issue Date:: 2025-03-12

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Field	Value	Language
dc.contributor.author	Lim, R
dc.contributor.author	Wiltshire, S
dc.contributor.author	Barnet, M
dc.contributor.author	Low, JP
dc.contributor.author	Bolitho, S
dc.contributor.author	Kane, A
dc.contributor.author	Jabbour, A
dc.contributor.author	Kotlyar, E
dc.contributor.author	Hayward, C
dc.date.accessioned	2025-09-15T03:42:27Z
dc.date.available	2025-09-15T03:42:27Z
dc.date.issued	2025-03-12
dc.identifier.citation	Am J Case Rep, 2025, 26, pp. e945796
dc.identifier.issn	1941-5923
dc.identifier.issn	1941-5923
dc.identifier.uri	http://hdl.handle.net/10453/189843
dc.description.abstract	BACKGROUND Cardiomyopathy associated with thymoma is thought to be a cardiac manifestations of myasthenia gravis (MG). However, there are case reports of newly diagnosed thymoma presenting with cardiomyopathy without MG, and the mechanism remains unclear. The purpose of this report is to explore tachycardia-induced cardiomyopathy (TIC) as a potential mechanism for cardiomyopathy in thymoma without features of MG. CASE REPORT A 31-year-old man presented with atrial flutter with right bundle branch block and severe biventricular heart failure. Echocardiogram revealed severe left ventricle ejection fraction (LVEF) of 15% with biventricular dilation with impaired systolic function. Computer tomography coronary angiography demonstrated normal coronary artery disease. Cardiac magnetic resonance imaging showed normal T1 and T2 mapping, without inflammation or edema. A large anterior mediastinal mass was found on computer tomography chest. Mediastinal mass biopsy identified type B3 thymoma (WHO classification) with dual population of large, uniform epithelial thymic cells and immature T cell phenotype. Acetylcholine receptor antibody was positive without clinical features of MG and hypogammaglobulinemia indicating Good syndrome. He was treated with antiarrhythmic and heart failure pharmacotherapy, carboplatin and paclitaxel, and intravenous immunoglobulin. He demonstrated reversible heart failure following abolishment of tachyarrhythmia, consistent with tachycardia-induced cardiomyopathy. CONCLUSIONS We report a rare case of a newly diagnosed thymoma and Good syndrome without clinical features of MG presenting with tachyarrhythmia and severe biventricular failure. The reversibility of the cardiomyopathy following abortion of tachyarrhythmia with treatment highlights TIC as a potential cause.
dc.format	Electronic
dc.language	eng
dc.publisher	International Scientific Information
dc.relation.ispartof	Am J Case Rep
dc.relation.isbasedon	10.12659/AJCR.945796
dc.rights	info:eu-repo/semantics/openAccess
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.mesh	Humans
dc.subject.mesh	Thymoma
dc.subject.mesh	Male
dc.subject.mesh	Thymus Neoplasms
dc.subject.mesh	Adult
dc.subject.mesh	Heart Failure
dc.subject.mesh	Myasthenia Gravis
dc.subject.mesh	Tachycardia
dc.subject.mesh	Cardiomyopathies
dc.subject.mesh	Echocardiography
dc.subject.mesh	Humans
dc.subject.mesh	Thymoma
dc.subject.mesh	Thymus Neoplasms
dc.subject.mesh	Myasthenia Gravis
dc.subject.mesh	Tachycardia
dc.subject.mesh	Cardiomyopathies
dc.subject.mesh	Echocardiography
dc.subject.mesh	Adult
dc.subject.mesh	Male
dc.subject.mesh	Heart Failure
dc.subject.mesh	Humans
dc.subject.mesh	Thymoma
dc.subject.mesh	Male
dc.subject.mesh	Thymus Neoplasms
dc.subject.mesh	Adult
dc.subject.mesh	Heart Failure
dc.subject.mesh	Myasthenia Gravis
dc.subject.mesh	Tachycardia
dc.subject.mesh	Cardiomyopathies
dc.subject.mesh	Echocardiography
dc.title	Thymoma-Induced Severe Biventricular Failure without Myasthenia Gravis: Investigating Tachycardia-Induced Cardiomyopathy.
dc.type	Journal Article
utslib.citation.volume	26
utslib.location.activity	United States
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Engineering and Information Technology
pubs.organisational-group	University of Technology Sydney/Faculty of Engineering and Information Technology/School of Biomedical Engineering
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/INSIGHT: Institute for Innovative Solutions for Wellbeing and Health
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.date.updated	2025-09-15T03:42:26Z
pubs.publication-status	Published online
pubs.volume	26

Abstract:

BACKGROUND Cardiomyopathy associated with thymoma is thought to be a cardiac manifestations of myasthenia gravis (MG). However, there are case reports of newly diagnosed thymoma presenting with cardiomyopathy without MG, and the mechanism remains unclear. The purpose of this report is to explore tachycardia-induced cardiomyopathy (TIC) as a potential mechanism for cardiomyopathy in thymoma without features of MG. CASE REPORT A 31-year-old man presented with atrial flutter with right bundle branch block and severe biventricular heart failure. Echocardiogram revealed severe left ventricle ejection fraction (LVEF) of 15% with biventricular dilation with impaired systolic function. Computer tomography coronary angiography demonstrated normal coronary artery disease. Cardiac magnetic resonance imaging showed normal T1 and T2 mapping, without inflammation or edema. A large anterior mediastinal mass was found on computer tomography chest. Mediastinal mass biopsy identified type B3 thymoma (WHO classification) with dual population of large, uniform epithelial thymic cells and immature T cell phenotype. Acetylcholine receptor antibody was positive without clinical features of MG and hypogammaglobulinemia indicating Good syndrome. He was treated with antiarrhythmic and heart failure pharmacotherapy, carboplatin and paclitaxel, and intravenous immunoglobulin. He demonstrated reversible heart failure following abolishment of tachyarrhythmia, consistent with tachycardia-induced cardiomyopathy. CONCLUSIONS We report a rare case of a newly diagnosed thymoma and Good syndrome without clinical features of MG presenting with tachyarrhythmia and severe biventricular failure. The reversibility of the cardiomyopathy following abortion of tachyarrhythmia with treatment highlights TIC as a potential cause.

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http://hdl.handle.net/10453/189843