Spinal blastomycosis--case report.

late-onset cases, has yet to be clarified.' 2 Olanow et al.3 reported excellent results with thymectomy in 12 patients with late-onset myasthenia gravis. One of these had a thymolipoma. This tumour has, to our knowledge, only been reported in the world literature as a cause for myasthenia gravis in two other cases.4 ' We therefore present the fourth case in this paper. In May 1980 a 61-year-old man noted diplopia for the first time. In September he complained of a weakness of the jaw and neck muscles, dysarthria and problems with swallowing. The muscles of the limbs were not affected, but there was weakness of the sphincter ani muscles with incontinence. The diagnosis was substantiated by observing the response to edrophonium chloride. Chest radiographs showed no mediastinal abnormalities. Thymectomy was discussed, but not performed. Treatment with pyridostigmine 250 mg per day improved the myasthenic symptoms apart from the weakness of the sphincter muscles. In July 1981 the patient made a spontaneous recovery and for three months no medication was needed. Then he relapsed, at which time the limbs also were affected. In October 1981 treatment with dex-amethasone 16 mg per day was given for 10 days, and until January 1982 he did well on pyridostigmine 200 mg per day. Thereafter his myasthenic symptoms worsened, and treatment with prednisone was initiated in an intensive care unit initially with 60 mg per day together with pyridostig-mine up to 540 mg per day. In April 1982 he was discharged with only slight myas-thenic symptoms, but the following day he was readmitted with acute myocardial infarction. During hospitalisation he suffered a second acute myocardial infarction from which he also recovered without serious complications. The patient gradually deteriorated despite treatment with pyridostigmine 300 mg per day and pred-nisone 15 mg per day. He had some degree of respiratory embarrassment, and among other complications was treated for an abscess of the lung. Talking and swallowing became difficult, and he needed a collar to support his neck. In October 1982 transsternal thymec-tomy was performed and surprisingly 65 g of apparently thymic tissue was removed. Macroscopic findings: the tissue fragments measured 7 x 7 x 3 cm, 4-5 x 1 x 1 cm and 3 x 2 x 1 cm (three parts) and weighed 65 g. The tissue was soft, yellow and lobulated. A thin capsule covered almost the entire tissue. On cross-section it appeared to be mature …