Indeed, clinically, appreciable rates of coexistent autoimmune disorders have been observed in patients with LGI1 antibodies,14 and several patients with CASPR2 antibody have been reported to have both thymomas and myasthenia gravis.13 Taken together, these observations hint that more than one ‘hit’ may be required to generate disease: an underlying immunological profile, combined with a predisposing event or antigenic exposure (figure 3). Here, CNTNAP2 is linked to thymoma.