CASE REPORT Coexistence of Aspergillosis of the Breast and Mediastinal Thymoma with Myasthenia Gravis: A Rare Entity Haris Jafri 1 & Gaurav Panchal 1 & Nilanjan Roy 1 & Pankaj P. Rao 1 & Isha Sharma 2 Received: 26 June 2020 /Accepted: 14 July 2020 # Association of Surgeons of India 2020 Abstract Aspergillosis of the breast is very uncommon and associated with various immunosuppressed states. Spectrum of disease extends from cutaneous to disseminated invasive aspergillosis. Only 13 cases of aspergillosis breast have been reported so far with seven of them associated with immunocompromised states. Our case brings out the rare association of aspergillosis of the breast with thymoma and myasthenia gravis (MG) managed successfully and has not been reported in world literature so far. It highlights the importance of understanding the association of autoimmune diseases with aspergillosis. Keywords Aspergillosis . Myasthenia gravis (MG) . Thymoma . Mediastinal mass . Immunocompromised Introduction Aspergillus causes a wide spectrum of diseases ranging from aspergilloma to invasive aspergillosis [1]. Primary aspergillo- sis of the breast and chest wall is rare and till date only 13 cases of aspergillosis breast have been reported so far out of which seven of them were immunocompromised having acute myeloid leukaemia, diabetes mellitus, postoperative status for breast carcinoma, three cases of lung transplantation and post breast implant surgery as comorbidities respectively [2]. Coexistence of aspergillosis with mediastinal aspergilloma in an immunocompetent host has been reported in one patient so far which was a part of the same spectrum of disease [3]. We present a case of aspergillosis breast who had mediastinal mass lesion which later turned out be thymoma and further radioimmunoassay (RIA) studies confirmed the patient to have myasthenia gravis (MG) with both entities not a part of the same spectrum of illness which is a rare event. As far as our knowledge goes, this is the first ever case worldwide of aspergillosis breast attributable to immunocompromised state due to thymoma and MG which was evaluated and managed successfully at a tertiary care centre. Case Report A 75-year-old lady with no known comorbidities presented with history of inflammatory swelling of the right breast with no history of trauma, drug intake or intralesional injections. Swelling progressed to fungating soft tissue mass of 8 × 12 cm size over a period of 4 months (Fig. 1). The patient also had solitary palpable right anterior axillary lymph node. Wedge biopsy of the lesion showed multiple septate fungal hyphae with acute angled branching on haematoxylin and eosin (H&E) stained sections which was also confirmed by special stains like periodic acid Schiff (Fig. 2a) and Grocott stain (Fig. 2b). A computed tomography (CT) scan of the chest revealed features of necrotising soft tissue infection (NSTI) of the right breast with an anterior mediastinal mass lesion of size 52× 45 × 50 mm abutting the main pulmonary artery posteromedially and chest wall anteriorly without infiltrating * Gaurav Panchal gauravpanchalafmc@gmail.com Haris Jafri harick_14@yahoo.com Nilanjan Roy nilanjanroyd604@rediffmail.com Pankaj P. Rao pankajrao@rediffmail.com Isha Sharma ishasharma5872@gmail.com 1 Department of Surgery, Armed Forces Medical College, Pune, India 2 Department of Pathology, Armed Forces Medical College, Pune, India Indian Journal of Surgery https://doi.org/10.1007/s12262-020-02533-z