Post thymectomy, thymoma recurrence presented with myasthenic crisis after three decades in myasthenia gravis patient - A rare case report

Background: Thymomas are rare epithelial tumors of the anterior mediastinum frequently associated with myasthenia gravis (MG)1. Although recurrence is typically seen within a decade of resection, late recurrences have been described2. Very late recurrence after 30 years is extremely rare, and presentation with myasthenic crisis is rarer still5, 6. Case Presentation: We present a case of a 65-year-old female with MG, diagnosed at the of age 35, who underwent complete thymectomy for WHO type B2 thymoma. She remained clinically stable on low-dose treatment. Three decades later, she presented with respiratory failure, bulbar weakness, and generalized fatigability. She was diagnosed with myasthenic crisis and put on ventilatory support. Imaging studies revealed an anterior mediastinal mass; biopsy confirmed recurrent thymoma. Conclusion: This case highlights the potential for extremely late recurrence of thymoma and the need for clinical vigilance in MG patients presenting with crisis, even decades after surgical remission. Long-term or lifelong follow-up may be required.