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Ye Y, Wang J, Bao B, Chen G, Hu A, Sun J, Liu W. Good syndrome combined with multiple microbial pulmonary infections: case report and review of the literature. Immunol Res 2024:10.1007/s12026-024-09528-y. [PMID: 39180607 DOI: 10.1007/s12026-024-09528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024]
Abstract
Good syndrome (GS), a rare acquired immunodeficiency disorder characterized by thymoma and hypogammaglobulinemia, predisposes individuals to recurrent infections. This study reports a case of a 37-year-old male GS with multiple pulmonary infections and reviews relevant literature. The patient, with a history of thymoma resection, experienced multiple hospitalizations due to lung infections and neutropenia. The alveolar lavage fluid was detected by macro-genomic sequencing (NGS) to detect multiple pathogens, and targeted anti-infective and immunity-enhancing treatments led to improved symptoms and normal neutrophil counts. A literature review of 98 case reports from 2000 to 2023 was conducted, summarizing the associated diseases and pathogens in GS patients. Regular immunoglobulin monitoring in thymoma patients is essential for early GS diagnosis. When empirical antimicrobial therapy fails, mNGS for pathogen detection and targeted therapy are crucial, and regular IVIG injections can reduce infection rates in GS patients.
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Affiliation(s)
- Yucai Ye
- Department of Respiratory Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Juan Wang
- Department of Respiratory Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Bahu Bao
- Department of Respiratory Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Guorong Chen
- Department of Respiratory Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Aoyan Hu
- Department of Respiratory Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Jingzi Sun
- Department of Respiratory Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Weiying Liu
- Department of Respiratory and Critical Care Medicine, the First Hospital of Lanzhou University, No.1 Donggang West Road, Chengguan District, Lanzhou City, 730000, Gansu Province, China.
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Kobayashi T, Sato JI, Ikuta K, Kanno R, Nishiyama K, Koshizuka T, Ishioka K, Suzutani T. Modification of the HCMV-specific IFN-γ release test (QuantiFERON-CMV) and a novel proposal for its application. Fukushima J Med Sci 2017. [PMID: 28638004 DOI: 10.5387/fms.2017-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Human cytomegalovirus (HCMV) is universally distributed among humans without any adverse effects; however, it induces severe diseases in immunocompromised patients such as organ transplant recipients and AIDS patients. To manage these immunocompromised patients, an easy clinical examination for the monitoring of disease risk is required. In this study, we modified the interferon-γ (IFN-γ) release test (QuantiFERON®-CMV) using HCMV immediate early-1 (IE-1) or pp65 whole proteins, or UV-inactivated HCMV particles as an antigen. The response of heparinized peripheral blood from healthy volunteers to the pp65 protein showed an obvious dose-dependent sigmoid curve, although no correlation was observed between results of this assay and an ELISPOT assay. The addition of pp65 to the blood samples at a final concentration of 1×103 to 1×105 pg/ml was found to be optimum. Using this assay, we observed a significant enhancement in cellular immunity in volunteers after the daily ingestion of yogurt for 8 weeks, which suggested a novel application of the assay in addition to monitoring HCMV infection risk. IFN-γ secretion from peripheral blood cells on HCMV-antigen stimulation differed significantly between individuals; therefore, the assay could not be normalized. Nevertheless, it was found to be particularly useful for observing fluctuations in cellular immune activity on an individual level.
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Affiliation(s)
- Takahiro Kobayashi
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Jun-Ichi Sato
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Kazufumi Ikuta
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima.,Division of Microbiology, Tohoku Medical and Pharmaceutical University
| | - Ryoko Kanno
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Kyoko Nishiyama
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Tetsuo Koshizuka
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Ken Ishioka
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Tatsuo Suzutani
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
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Jansen A, van Deuren M, Miller J, Litzman J, de Gracia J, Sáenz-Cuesta M, Szaflarska A, Martelius T, Takiguchi Y, Patel S, Misbah S, Simon A. Prognosis of Good syndrome: mortality and morbidity of thymoma associated immunodeficiency in perspective. Clin Immunol 2016; 171:12-17. [PMID: 27497628 DOI: 10.1016/j.clim.2016.07.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/25/2016] [Accepted: 07/30/2016] [Indexed: 02/07/2023]
Abstract
Good syndrome (GS) or thymoma-associated immunodeficiency, is a rare condition that has only been studied in retrospective case series. General consensus was that GS has a worse prognosis than other humoral immunodeficiencies. In this study, physicians of GS patients completed two questionnaires with a two year interval with data on 47 patients, 499 patient years in total. Results on epidemiology, disease characteristics, and outcome are presented. Mean age at diagnosis was 60years and median follow-up from onset of symptoms was 9years. There was a high frequency of respiratory tract infections due to encapsulated bacteria. Median survival was 14years. Survival was reduced compared to age-matched population controls (5-year survival: 82% versus 95%, p=0.008). In this cohort survival was not associated with gender (HR 0.9, 95% CI 0.3-3.0), autoimmune diseases (HR 2.9, 95% CI 0.8-10.1) or immunosuppressive use (HR 0.3, 95% CI: 0.1-1.2).
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Affiliation(s)
- Anne Jansen
- Nijmegen Center for Immunodeficiency and Autoinflammation (NCIA), Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Marcel van Deuren
- Nijmegen Center for Immunodeficiency and Autoinflammation (NCIA), Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joanne Miller
- Department of Immunology, John Radcliffe Hospital, Oxford, United Kingdom.
| | - Jiri Litzman
- Department of Clinical Immunology and Allergology, Faculty of Medicine, Masaryk University, St Anne's University Hospital, Brno, Czech Republic.
| | - Javier de Gracia
- Department of Pulmonary Diseases, Universitat Autònoma de Barcelona, CIBER Ciberes. Barcelona, Spain.
| | - Matías Sáenz-Cuesta
- Donostia University Hospital, Biodonostia Health Research Institute, San Sebastian, Spain.
| | - Anna Szaflarska
- Department of Clinical Immunology and Transplantology, Jagiellonian University, Medical College and Children University Hospital, Cracow, Poland.
| | - Timi Martelius
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | | | - Smita Patel
- Department of Immunology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Siraj Misbah
- Department of Immunology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Anna Simon
- Nijmegen Center for Immunodeficiency and Autoinflammation (NCIA), Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Vallet H, Houitte R, Azria A, Mariette X. Cytomegalovirus colitis and hypo-IgG after rituximab therapy for rheumatoid arthritis. J Rheumatol 2011; 38:965-6. [PMID: 21532065 DOI: 10.3899/jrheum.100818] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Actis GC, Rosina F, Mackay IR. Inflammatory bowel disease: beyond the boundaries of the bowel. Expert Rev Gastroenterol Hepatol 2011; 5:401-10. [PMID: 21651357 DOI: 10.1586/egh.11.23] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dysregulated inflammation in the gut, designated clinically as inflammatory bowel disease (IBD), is manifested by the prototypic phenotypes of an Arthus-like reaction restricted to the mucosa of the colon, as in ulcerative colitis, or a transmural granulomatous reaction, as in Crohn's disease, or an indeterminate form of the two polar types. That the inflammation of IBD can trespass the boundaries of the bowel has long been known, with articular, ophthalmologic, cutaneous, hepatobiliary or other complications/associations - some autoimmune and others not - affecting significant numbers of patients with IBD. Also notable is the frequency of diagnosis of IBD-type diseases on a background of systemic, (mostly myelo-hematological) disorders, associated with alterations of either (or both) innate or adaptive arms of the immune response. Finally, cases of IBD are reported to occur as an adverse effect of TNF inhibitors. Bone marrow transplant has been proven to be the only curative measure for some of the above cases. Thus, in effect, the IBDs should now be regarded as a systemic, rather than bowel-localized, disease. Genome-wide association studies have been informative in consolidating the view of three phenotypes of IBD (ulcerative colitis, Crohn's disease and mixed) and, notably, are revealing that the onset of IBD can be linked to polymorphisms in regulatory miRNAs, or to nucleotide sequences coding for regulatory lymphokines and/or their receptors. At the effector level, we emphasize the major role of the Th17/IL-23 axis in dictating the perpetuation of intestinal inflammation, augmented by a failure of physiological control by regulatory T-cells. In conclusion, there is a central genesis of the defects underlying IBD, which therefore, in our opinion, is best accommodated by the concept of IBD as more of a syndrome than an autonomous disease. This altered mindset should upgrade our knowledge of IBD, influence its medical care and provide a platform for further advances.
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Affiliation(s)
- Giovanni C Actis
- Department of Gastro-Hepatology, Ospedale Gradenigo, Corso Regina Margherita 10, Torino 10153, Italy.
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de Bucourt M, Swierzy M, Dankof A, Teichgräber U, Rückert JC. Observation and extirpation of a giant-size type-B2 thymoma IIb with its histological, macroscopic, and computer tomogram correlate, and literature review. Rare Tumors 2010; 2:e30. [PMID: 21139832 PMCID: PMC2994517 DOI: 10.4081/rt.2010.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 04/20/2010] [Accepted: 04/23/2010] [Indexed: 11/23/2022] Open
Abstract
This report describes the interdisciplinary approach and solving algorithm of a DIN 9001:2000 certified tumor board in managing a giant-size type-B2 thymoma IIb in an elderly patient. The process of managing the thymoma with specialists of surgery, internal medicine, radiology, and pathology until finally extirpation and continuous follow-up is described. Respective computerized tomography scans, histology, macro-pathology, and operative pictures of the case are provided as well as an upto-date literature review.
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Kelesidis T, Yang O. Good's syndrome remains a mystery after 55 years: A systematic review of the scientific evidence. Clin Immunol 2010; 135:347-63. [PMID: 20149753 DOI: 10.1016/j.clim.2010.01.006] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 01/17/2010] [Indexed: 11/17/2022]
Abstract
Good syndrome (GS) is a rare association of thymoma and immunodeficiency first described more than 50 years ago. However, this syndrome still remains a mystery to clinicians. We systematically reviewed all the clinical, laboratory and immunologic findings from 152 patients with Good syndrome. The syndrome has a worldwide distribution and approximately half of the cases (47%) have been described in Europe. The diagnosis of thymoma preceded the diagnosis of hypogammaglobulinemia, infection, or diarrhea in 42% of patients whereas in 38% of patients the diagnoses were made almost simultaneously within 2 months of each other. We found significant mortality in patients with this syndrome (44.5%). Astute clinical acumen and increased awareness about the clinical and immunological profile of this syndrome may increase early recognition of this syndrome and prevent mortality. Further studies are needed to elucidate this clinical entity.
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Affiliation(s)
- Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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