Mediastinal mass: to resect or not to resect?

We describe a case of a 63-year-old man presenting in an acute confusional state with a markedly abnormal chest radiograph. During investigation, he developed aspiration pneumonia and was ventilated on the intensive care unit before confirming that he had autoimmune encephalopathy secondary to benign thymoma. After treatment with intravenous immunoglobulins he made an impressive recovery allowing him to be transferred to a tertiary unit for resection of the underlying mass, thus resulting in an excellent neurological recovery.