Prolonged severe XXXX following thymectomy and radiation: a case report.

@entity1 @entity404 @entity704 @entity2905 @entity465 @entity1292 @entity405 @entity110
INTRODUCTION: @entity465 can occur both in @entity1 undergoing radiation therapy, as well as in @entity1 who have had thymectomies. However, few studies have examined the immune recovery of a @entity1 following both procedures. We aim to emphasize the need for assessment and consistent monitoring of @entity1 with @entity704 prior to and after combined treatment of thymectomy and radiation, both of which are likely to result in an increased risk for @entity465 . CASE PRESENTATION: We describe the longitudinal progress of a 59-year-old Asian male who underwent thymectomy followed by radiation therapy and subsequently presented with generalized @entity110 . Revelation of a low absolute lymphocyte count (615 cells/mcL) on initial evaluation prompted further analysis of his immunoglobulin levels and antigen response to a polysaccharide pneumococcal vaccine (PneumoVax-23). Although his immunoglobulin levels were unremarkable, he failed to respond to 11 of 12 serotypes of the pneumococcal vaccine. As a result, he was placed on Bactrim(R) (trimethoprim-sulfamethoxazole) prophylaxis to prevent @entity1292 , and his @entity404 + and @entity405 + counts were monitored over the course of 8 years. His lymphocyte counts 87 months after thymectomy and 85 months after radiation therapy were as follows: absolute lymphocyte count 956 cells/mcL, absolute CD3+/ @entity404 + 164/mm3 (16%) and absolute CD3+/ @entity405 + 257/mm3 (25%). The @entity1 was able to discontinue Bactrim(R) (trimethoprim-sulfamethoxazole) prophylaxis after 9 years of treatment. CONCLUSIONS: The @entity2905 , low @entity404 + count, and failed response to pneumococcal vaccination that presented in our @entity1 are consistent with @entity465 . After radiation alone, a recovery of T-lymphocytes is usually observed after approximately 3 weeks. Over the course of 8 years, he has still not made a full recovery according to laboratory markers, which seem to have stabilized at chronically low levels. To prevent serious complications, we suggest that @entity1 who have undergone both thymectomy and radiation therapy be monitored for @entity465 . This case report informs the practices of allergists, oncologists, and neurologists in the continuing care of @entity1 with @entity704 .
