I read the interesting manuscript entitled “Thymoma and autoimmune diseases” recently written by Jamilloux et al. In their paper, they stated that no characteristics or pathological information can predict the occurrence of an autoimmune disease after a thymectomy . However, I think this opinion may not be extended to all autoimmune diseases. For example, the association of systemic lupus erythematosus (SLE) with thymoma usually occurs in people older than the typical onset age of lupus. The association between thymoma, thymectomy, and SLE has been reported in several papers. Among these reports, pure red cell aplasia (a type of anemia affecting only the precursors to red blood cells in bone marrow) has been associated with thymoma and SLE in some cases [2-5], and in a few cases, SLE has appeared after the occurrence of pure red cell aplasia and thymectomy [2, 3]. Therefore, pure red cell aplasia in the presence of thymoma may be a predictive clinical feature of SLE in future years. This is a topic of interest which should be investigated in future studies. In my opinion, thymectomy should be avoided in patients with thymoma associated with red cell aplasia. Given the immune regulatory role of the thymus, removing it may facilitate the creation or aggravation of lupus in such cases. The appearance of SLE after thymectomy may be due to loss of central tolerance, the accumulation of self-reactive T-cells in peripheral circulation, or the overproduction of antibodies.
The author declares no conflicts of interest.