Case Report: Recurrent metastatic thymoma-associated multiple paraneoplastic syndromes: myasthenia gravis, dysgeusia, and acute intestinal pseudo-obstruction.

BACKGROUND: Paraneoplastic syndromes (PNS) are frequently associated with thymoma. The unusual clustering of myasthenia gravis, dysgeusia, and AIPO during thymoma recurrence has been sparsely reported in the literature. CASE PRESENTATION: We report the case of a man who developed pleural metastasis three years after thymoma resection and shortly thereafter experienced dysgeusia, ocular MG (diplopia and ophthalmoplegia), and AIPO. This triad has received limited documentation. Serum testing was positive for acetylcholine receptor antibody (AChR-Ab), anti-MURC antibody, and anti-recoverin antibody. After combined CAP chemotherapy and symptomatic pyridostigmine therapy, the pleural lesions regressed, and the ocular, taste, and gastrointestinal symptoms also resolved. CONCLUSION: This case illustrates that multisystem PNS can arise years after thymectomy and may cluster, emphasizing the need for early recognition and multidisciplinary, comprehensive management.