A 70-year-old male with a history of lymphocytic type (type B1) thymoma was excised in 2000.
Subsequently, he suffered from multiple upper and lower respiratory infections managed as outpatients with broad spectrum antibiotics, empirically.
The study of its immunity, in 2004, showed quantification of decreased immunoglobulins: IgG 497 mg/dl (800-1700), IgA 86 mg/dl (100-490) and IgM 21 mg/dl (40-250).
No flow cytometry study of lymphocyte populations was requested.
A humoral immunodeficiency was diagnosed and by the history of thymoma, a Good syndrome.
Since 2007, he received monthly intravenous gammaglobulin treatment.
In May 2009, a progressive installation of normocytic normochromic anemia that did not respond to vitamin B12 or folic acid was observed.
In December 2009, blood count showed hemoglobin 4.6 g/dl, normal leukocytes and platelets, MCV 108 and ferritin 845 ng/ml (12-300).
Myelogram showed absence of erythroblasts (< 1%), i.e., an absolute erythroblast, normal granulocytic and megakaryocytic series.
With the diagnosis of APSR treatment was initiated with prednisone 30 mg/day and cyclosporine 100 mg q12h, maintaining cyclosporin levels in the range of 200 ng/ml.
With this treatment a progressive increase of hemoglobin was observed, until its normalization at one month of treatment, in January 2010.
1.
Unfortunately, the patient suffered a fall at the level, resulting in pulmonary contusion and decreased ventilatory capacity due to pain.
This situation caused worsening of a respiratory infection, sepsis, and aspiration pneumonia, dying on February 28, 2010.
