Neuro-ophthalmic presentation of leptomeningeal metastasis of thymoma: a case report

TL;DR

A rare case of thymoma causing leptomeningeal metastasis with neuro-ophthalmic symptoms is reported, emphasizing the need for thorough imaging in advanced thymoma patients.

Contribution

This case report highlights the rare neuro-ophthalmic presentation of thymoma-related leptomeningeal metastasis and suggests the use of frequent PET scans for monitoring.

Findings

Thymoma-related leptomeningeal metastasis can present with neuro-ophthalmic symptoms like ptosis and diplopia.

PET scans are recommended for monitoring aggressive metastatic thymomas due to their rapid progression.

Clinicians should consider both neoplastic and paraneoplastic neuro-ophthalmic manifestations in thymoma patients.

Abstract

Leptomeningeal disease (LMD) of the brain and spinal cord can present with visual loss or diplopia. Although LMD can occur in many forms of neoplasia, thymoma-related LMD is exceedingly rare.

A 53-year-old Hispanic male with a history of chest pain, weight loss, and night sweats was diagnosed with stage 4 thymoma with lung and pleural metastasis. He received chemotherapy for metastatic thymoma. Few months later, patient presented with severe right-sided facial pain and lip numbness, ptosis and double vision.

The patient was diagnosed with multiple cranial and spinal nerve involvement due to thymomatous LMD, confirmed on magnetic resonance imaging and lumbar puncture.

LMD is a rare presentation of a malignant thymoma. Current guidelines for thymoma management emphasize the importance of staging imaging to rule out distant metastasis. Our case highlights the importance of a head-to-mid-thigh positron emission tomography (PET) scan in patients with known metastatic thymomas, with multiple PET scans, if possible, at regular intervals, owing to the aggressive nature of metastatic thymomas. Clinicians should be aware of the neoplastic (e.g., metastatic disease and LMD) and paraneoplastic (e.g., thymoma-related myasthenia gravis) neuro-ophthalmic presentations of thymoma.

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