Abnormal Liver Enzymes in Thymoma-Associated Multiorgan Autoimmunity

    October 2022 in “ ˜The œAmerican journal of gastroenterology ”
    Bianca Di Cocco, Hnin Ingyin, Michael J. Mintz, Cynthia M. Magro, David Wan
    TLDR Thymoma-associated multiorgan autoimmunity can cause liver damage and affects multiple organs, with limited treatment options and a generally poor prognosis.
    A 74-year-old man with myasthenia gravis and a malignant thymoma developed abnormal liver function tests (LFTs) and a widespread rash, initially thought to be due to antibiotics. However, skin and liver biopsies revealed thymoma-associated multiorgan autoimmunity (TAMA), a rare condition resembling graft-versus-host disease. The patient’s LFTs continued to worsen despite discontinuing the antibiotic, with total bilirubin reaching 28.4 mg/dL and ALT 698 U/L. Treatment involved antithyroglobulin (ATG) and dexamethasone. TAMA can affect multiple organs, and its pathophysiology may involve the absence of the autoimmune regulator in thymomas or decreased FoxP3-positive regulator T-cells. Treatment options are limited and prognosis is poor due to the rarity of the condition.
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