Abstract
Myasthenia gravis is an archetypal human autoimmune disease. Thymectomy is proven effective by controlled clinical trials, and is commonly part of the immunotherapeutic approach when myasthenia creates generalized weakness. Pemphigus foliaceus is also autoimmune but treated medically; and thymectomy is not part of therapy unless thymoma is discovered. Autoimmune mechanisms, age distribution, and response to therapy in autoimmune disorders are likely to be different with thymoma. The concurrence of generalized myasthenia with disfiguring pemphigus foliaceus in one young patient but without thymoma offered a natural experiment to assess immunologic antibody responsiveness postoperatively, and observe more than a quarter of a century of clinical remission of both following total thymectomy surgery.