胸腺之心：一个罕见的无重症肌无力的非缺血性心肌病故事
The Heart of the Thymus: A Rare Tale of Nonischemic Cardiomyopathy in the Absence of Myasthenia Gravis.
摘要(中文译文)
胸腺瘤是前纵隔罕见的罕见上皮性肿瘤，以与自身免疫及副肿瘤综合征相关而著称，其中最显著的是肌无力（MG）。心肌病是一种极为罕见的副肿瘤表现。新近的病例报告提示，胸腺瘤可能产生独立于MG的全身性效应，包括直接或免疫介导的心肌损伤。我们报告一例54岁男性，既往有非缺血性心肌病，因肺炎和胆囊炎导致脓毒性休克就诊，并发室性心律失常和失代偿性心力衰竭。影像学显示前纵隔钙化性肿块，后诊断为世界卫生组织（WHO）B型胸腺瘤。值得注意的是，该患者缺乏任何MG或其他自身免疫综合征的临床或血清学证据。心脏磁共振成像（MRI）排除了心肌炎和Takotsubo心肌病，而冠状动脉造影排除了缺血性疾病。尽管进行了抗凝治疗，左心室（LV）血栓仍持续存在。患者的心功能障碍需要机械通气、血管升压药和多学科心力衰竭治疗方案。本病例将胸腺瘤的表型扩展至传统副肿瘤谱之外。它强调了对不明原因心肌病病例提高临床警惕和多系统诊断方法的必要性。有必要进一步研究胸腺瘤中免疫介导的心脏损伤。
Abstract
Thymomas are rare epithelial tumors of the anterior mediastinum known for their association with autoimmune and paraneoplastic syndromes, most notably myasthenia gravis (MG). Cardiomyopathy is an exceptionally rare paraneoplastic manifestation. Emerging case reports suggest that thymoma may exert systemic effects independent of MG, including direct or immune-mediated myocardial injury. We report the case of a 54-year-old male with known nonischemic cardiomyopathy who presented with septic shock from pneumonia and cholecystitis, complicated by ventricular arrhythmias and decompensated heart failure. Imaging revealed a calcified anterior mediastinal mass, later diagnosed as a World Health Organization (WHO) type B thymoma. Notably, the patient lacked any clinical or serologic evidence of MG or other autoimmune syndromes. Cardiac magnetic resonance imaging (MRI) excluded myocarditis and takotsubo cardiomyopathy, while coronary angiography ruled out ischemic disease. Despite anticoagulation, a persistent left ventricular (LV) thrombus remained. The patient's cardiac dysfunction necessitated mechanical ventilation, vasopressors, and a multidisciplinary heart failure regimen. This case expands the phenotype of thymoma beyond the traditional paraneoplastic spectrum. It reinforces the need for heightened clinical suspicion and a multisystem diagnostic approach in cases of unexplained cardiomyopathy. Further investigation into immune-mediated cardiac injury in thymoma is warranted.
如何引用
AMA
Manish Barman, Bassem Al Hariri, Tasneem Babiker, Mohamed Gadkarem, Joudi Alhariri, Ahmad Alharafsheh. The Heart of the Thymus: A Rare Tale of Nonischemic Cardiomyopathy in the Absence of Myasthenia Gravis.. Clinical case reports. 2026; doi:10.1002/ccr3.72120.
APA
Manish Barman, Bassem Al Hariri, Tasneem Babiker, Mohamed Gadkarem, Joudi Alhariri, Ahmad Alharafsheh (2026). The Heart of the Thymus: A Rare Tale of Nonischemic Cardiomyopathy in the Absence of Myasthenia Gravis.. Clinical case reports. https://doi.org/10.1002/ccr3.72120
GB/T 7714
Manish Barman, Bassem Al Hariri, Tasneem Babiker, Mohamed Gadkarem, Joudi Alhariri, Ahmad Alharafsheh. The Heart of the Thymus: A Rare Tale of Nonischemic Cardiomyopathy in the Absence of Myasthenia Gravis.[J]. Clinical case reports, 2026 doi:10.1002/ccr3.72120.
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