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Zhang T, Li H, Hou S, Yu H, Yue W. Case report of Ureaplasma urealyticum meningitis in a patient with thymoma and hypogammaglobulinaemia. BMC Infect Dis 2021; 21:1142. [PMID: 34749670 PMCID: PMC8573917 DOI: 10.1186/s12879-021-06831-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ureaplasma urealyticum (UU) is found among the normal vaginal flora in a considerable proportion of asymptomatic women; however, adult central nervous system (CNS) infection of UU is extremely rare. Good's syndrome (GS) is an adult-onset immunodeficiency characterized by thymoma, hypogammaglobulinaemia, low or absent B‑cells, and an inverted CD4+/CD8+ T‑cell ratio. Patients with GS usually have severe or recurrent infections. Case presentation We describe the case report of a 49-year-old woman who developed UU meningitis. Initial routine anti-viral and anti-bacterial therapy showed no improvement in the patient's condition. Next-generation sequencing (NGS) of cerebrospinal fluid (CSF) identified the UU DNA sequence. Accordingly, a diagnosis of UU meningitis was made, and minocycline therapy was initiated. The patient responded favourably, with no signs of disease at subsequent follow-up. According to the severity and rarity of the case, secondary immunodeficiency was suspected. Flow cytometry found hypogammaglobulinaemia. Combined with the previous history of thymoma, the patient was diagnosed with immune deficiency disease of GS. Conclusions This case may be the first adult case report in the literature describing UU meningitis in a patient with GS. The diagnosis of GS should be considered in patients presenting with unexplained antibody deficiency and thymoma.
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Affiliation(s)
- Ting Zhang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.,Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Haiyan Li
- Department of Otolaryngology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuping Hou
- Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huanxin Yu
- Department of Otolaryngology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Wei Yue
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China. .,Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China.
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Ni J, Zhang J, Chen Y, Wang W, Liu J. Variable clinical characteristics and laboratory results in five patients with Chinese Good's syndrome (thymoma and hypogammaglobulinemia): an 8-year retrospective analysis in a university hospital in China. BMC Immunol 2021; 22:50. [PMID: 34344301 PMCID: PMC8328998 DOI: 10.1186/s12865-021-00441-9] [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: 10/25/2020] [Accepted: 07/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background Good's syndrome (GS) is a rare secondary immunodeficiency disease presenting as thymoma and hypogammaglobulinemia. Due to its rarity, the diagnosis of GS is often missed. Methods We used the hospital information system to retrospectively screen thymoma and hypogammaglobulinemia patients at the First Affiliated Hospital of Wenzhou Medical University from Apr 2012 to Apr 2020. The clinical, laboratory, treatment, and outcome data for these patients were collected and analyzed. Results Among the 181 screened thymoma patients, 5 thymoma patients with hypogammaglobulinemia were identified; 3 patients had confirmed diagnoses of GS, and the other 2 did not have a diagnosis of GS recorded in the hospital information system. A retrospective review of the clinical characteristics, laboratory results, and follow-up data for these 2 undiagnosed patients confirmed the diagnosis of GS. All 5 GS patients presented with pneumonia, 2 patients presented with recurrent skin abscesses, 2 patients presented with recurrent cough and expectoration, 1 patient presented with recurrent oral lichen planus and diarrhea, and 1 patient presented with tuberculosis and granulomatous epididymitis. In the years after the diagnosis of hypogammaglobulinemia with mild symptoms, all 5 patients had received irregular intravenous immunoglobulin (IVIG) treatment. As the course of the disease progressed, the clinical symptoms of all patients worsened, but the symptoms were partly resolved with IVIG in these patients. However, 4 patients died due to comorbidities. Conclusion GS should be investigated as a possible diagnosis in thymoma patients who present with hypogammaglobulinemia, especially those with recurrent opportunistic infections, recurrent skin abscesses, chronic diarrhea, or recurrent lichen planus.
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Affiliation(s)
- Jinyao Ni
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Junwu Zhang
- Department of Clinical Laboratory , Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, 9 Jiaowei Road, Wenzhou, 325000, China
| | - Yanxia Chen
- Department of Rheumatology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, China
| | - Weizhong Wang
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, China.
| | - Jinlin Liu
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, China.
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3
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Chen S, Liu J, Lin Y, Gao Y. Good's syndrome with a relapsed bloodstream infection induced by Alcaligenes sp. after thymectomy: A case report. Exp Ther Med 2021; 21:399. [PMID: 33680121 PMCID: PMC7918125 DOI: 10.3892/etm.2021.9830] [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: 10/31/2019] [Accepted: 12/14/2020] [Indexed: 12/02/2022] Open
Abstract
Good's syndrome (GS) or thymoma-associated immunodeficiency is a rare clinical syndrome with poor prognosis. The varied and unspecified clinical manifestations of GS commonly lead to a missed or delayed diagnosis. Thus, misdiagnosis and missed diagnosis are common. The present case study reports on a patient who suffered from a relapsed bloodstream infection caused by Alcaligenes sp. 6 months after thymectomy. The patient was finally diagnosed with GS after analyzing the clinical features and detecting T-lymphocyte subsets in the peripheral blood and humoral immune function. The patient's condition improved after anti-infection treatment and supplementation with intravenous immunoglobulin. Furthermore, no infection was observed during the 1-year follow-up.
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Affiliation(s)
- Sumei Chen
- Department of Infectious Diseases, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Jiangfu Liu
- Department of Infectious Diseases, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Yongnian Lin
- Department of Infectious Diseases, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Yipeng Gao
- Department of Infectious Diseases, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
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Oyenuga M, Shaikh S, Harris B, Sinha J, Lacasse A. Recurrent neutropenia and chronic diarrhea following thymectomy: the good, the bad, and the ugly. J Community Hosp Intern Med Perspect 2021; 11:263-265. [PMID: 33889334 PMCID: PMC8043559 DOI: 10.1080/20009666.2021.1877400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Good syndrome (GS) is a rare paraneoplastic syndrome seen before or after diagnosis of thymoma, and its treatment, and is characterized by hypogammaglobulinemia. Rarely, pure white cell aplasia (PWCA) can also be seen which can present as recurrent neutropenia. We describe a 64-year-old man with recurrent sinus infections and previous thymectomy for stage 1 type B2 thymoma presenting with chronic diarrhea and recurrent neutropenia necessitating serial hospitalizations despite repeated antimicrobial treatment. Immunoglobulin levels, including IgM, IgA, IgD, and IgE were undetectable. Flow cytometry also showed absent B cells. Patient was initiated on immunoglobulin replacement therapy with consequent significant clinical improvement. Despite thymectomy, patients can develop thymoma-associated paraneoplastic syndromes, including GS.
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Affiliation(s)
- Mosunmoluwa Oyenuga
- Department of Internal Medicine, SSM St. Mary's Hospital, St. Louis, MO, USA
| | - Safia Shaikh
- Department of Internal Medicine, SSM St. Mary's Hospital, St. Louis, MO, USA
| | - Benjamin Harris
- Department of Internal Medicine, SSM St. Mary's Hospital, St. Louis, MO, USA
| | - Jyotsana Sinha
- Department of Hematology/Oncology, SSM St. Mary's Hospital, St. Louis, MO, USA
| | - Alexandre Lacasse
- Department of Internal Medicine, SSM St. Mary's Hospital, St. Louis, MO, USA
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Mahdaviani SA, Rezaei N. Pulmonary Manifestations of Predominantly Antibody Deficiencies. PULMONARY MANIFESTATIONS OF PRIMARY IMMUNODEFICIENCY DISEASES 2019. [PMCID: PMC7123456 DOI: 10.1007/978-3-030-00880-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Predominantly antibody deficiencies (PADs) are the most frequent forms of primary immunodeficiency diseases (PIDs). Commonly accompanied with complications involving several body systems, immunoglobulin substitution therapy along with prophylactic antibiotics remained the cornerstone of treatment for PADs and related complications. Patients with respiratory complications should be prescribed an appropriate therapy as soon as possible and have to be adhering to more and longer medical therapies. Recent studies identified a gap for screening protocols to monitor respiratory manifestations in patients with PADs. In the present chapter, the pulmonary manifestations of different PADs for each have been discussed. The chapter is mainly focused on X-linked agammaglobulinemia, common variable immunodeficiency, activated PI3K-δ syndrome, LRBA deficiency, CD19 complex deficiencies, CD20 deficiency, other monogenic defects associated with hypogammaglobulinemia, immunoglobulin class switch recombination deficiencies affecting B-cells, transient hypogammaglobulinemia of infancy, and selective IgA deficiency.
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Affiliation(s)
- Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies Children’s Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Aberrant Peripheral Immune Function in a Good Syndrome Patient. J Immunol Res 2018; 2018:6212410. [PMID: 29850635 PMCID: PMC5937423 DOI: 10.1155/2018/6212410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/09/2018] [Accepted: 03/29/2018] [Indexed: 01/09/2023] Open
Abstract
Good's syndrome (GS) is often accompanied by recurrent respiratory infections and chronic diarrhea. The main purpose was to evaluate the peripheral immune status of a GS patient after thymoma resection. Twenty healthy volunteers were recruited as healthy controls (HCs). Flow cytometry was applied to determine the proportions of circuiting CD4+ T cells, CD8+ T cells, γδT cells, and regulatory T (Treg) cells in our GS patient. We also examined the proliferation capability of ex vivo CD4+ T cells and detected the levels of cytokines interferon- (IFN-) γ and interleukin-17A secreted by ex vivo immune cells from this GS patient. Compared with healthy control subjects, this GS patient had fewer B cells, an inverted ratio of CD4+/CD8+ cells, and more Treg cells in his peripheral blood. Additionally, the patient's Vδ2 T cell levels were significantly decreased despite having a normal percentage of γδT cells. Ex vivo peripheral CD4+ T cells from the patient showed insufficient proliferation and division potential as well as excessive expression of PD-1. Moreover, IFN-γ was predominantly derived from CD8+ T cells in this GS patient, rather than from CD4+ T cells and γδT cells. This GS patient had impaired T and B cell immunological alternations and cytokine disruptions after thymectomy. Detailed research should focus on therapies that can adjust the immune status in such patients for a better outcome.
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7
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Dong JP, Gao W, Teng GG, Tian Y, Wang HH. Characteristics of Good's Syndrome in China: A Systematic Review. Chin Med J (Engl) 2017; 130:1604-1609. [PMID: 28639577 PMCID: PMC5494925 DOI: 10.4103/0366-6999.208234] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Good's syndrome (GS) is a rare disease characterized by thymoma, hypogammaglobulinemia, low or absent B-cells, decreased T-cells, an inverted CD4+/CD8+ T-cell ratio and reduced T-cell mitogen proliferative responses. GS is difficult to diagnose preoperatively due to its rarity and lack of typical symptoms, the characteristics of Chinese GS patients are still lacking. This study aimed to systematically review all the clinical, laboratory, and immunologic findings of reported cases of Chinese patients with GS. METHODS We searched for case reports and articles up to January 2017 using PubMed, China National Knowledge Infrastructure, Wangfang database and China Science and Technology Journal Database with the following words in combinations as key words: "thymoma," "hypogammaglobulinemia," and "Good's syndrome." The text words and MeSH terms were entered depending on the databases characteristics. The reference lists from retrieved articles were also screened for additional applicable studies. The authors were restricted to Chinese. There was no language restriction. RESULTS Forty-seven patients were reported in 27 studies. We found that GS has a nationwide distribution and that most cases (83%) have been described on the mainland of China. The initial clinical presentation is varied, ranging from symptoms related to the thymoma to infections resulting from immunodeficiency. Type AB (50%) is the most common histologic type of thymomas in Chinese GS patients according to the World Health Organization classification of thymomas. With respect to infection, sinopulmonary infection (74%) is the most common type, followed by skin infection (10%) and intestinal tract infection (10%). Diarrhea was presented in 36% of patients, and autoimmune manifestations were presented in 36% of patients. CONCLUSIONS GS is a rare association of thymoma and immunodeficiency with a poor prognosis. Astute clinical acumen and increased awareness of the clinical and immunological profile of GS are needed to increase early diagnosis, that would benefit improved therapeutic effects.
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Affiliation(s)
- Jin-Pei Dong
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Wen Gao
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Gui-Gen Teng
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Yu Tian
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Hua-Hong Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
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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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9
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DeBoard ZM, Taylor BJW. Good's Syndrome: Successful Management of Thymoma With Hypoimmunoglobulinemia. Ann Thorac Surg 2016; 100:1903-5. [PMID: 26522540 DOI: 10.1016/j.athoracsur.2014.12.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 11/17/2014] [Accepted: 12/23/2014] [Indexed: 11/17/2022]
Abstract
We report a case of Good's syndrome managed with surgery and immunotherapy in a 58-year-old man who presented with a left arm skin infection and cough for 2 months. Imaging and laboratory studies revealed a large anterior mediastinal mass and panhypoimmunoglobulinemia, respectively. A biopsy was consistent with thymoma, and a diagnosis of Good's syndrome was established. Thymectomy was followed by intravenous immunoglobulin G and filgrastim with complete recovery through 9 months after discharge. Good's syndrome remains a rare entity often associated with poor prognosis. Adequate surgical resection remains key to outcomes, whereas immunotherapy aids in reducing postoperative complications and may improve survival.
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Affiliation(s)
- Zachary M DeBoard
- Departments of Surgery and Cardiothoracic Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California.
| | - Benedict J W Taylor
- Departments of Surgery and Cardiothoracic Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California
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Sun X, Shi J, Wang M, Xu K, Xiao Y. Good's Syndrome Patients Hospitalized for Infections: A Single-Center Retrospective Study. Medicine (Baltimore) 2015; 94:e2090. [PMID: 26632723 PMCID: PMC5058992 DOI: 10.1097/md.0000000000002090] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Good's syndrome (GS) is a rare combination of thymoma and hypogammaglobulinemia, resulting in immunodeficiency. Patients with GS are highly susceptible to bacterial infection, particularly encapsulated bacterial infection in upper and lower respiratory tracts. Good's syndrome patients with moderate-to- severe infection are often hospitalized. Clinical features of GS patients remain to be characterized.Patients with the discharge diagnosis of GS and simultaneous infection from Peking Union Medical College Hospital between January 2001 and July 2015 were retrospectively analyzed.Among 14 hospitalized GS patients, 12 of them were admitted for severe infections. Mean patient age was 56.7 + 10.1 years. Average concentrations of serum IgG, IgA, and IgM were 2.3 + 1.9 g/L, 0.28 + 0.28 g/L, and 0.06 + 0.07 g/L, respectively. Respiratory and intestinal tracts were the most common sites for infection, which occurred in 7 and 4 patients, respectively. Pathogens identified in 10 patients included cytomegalovirus in 5 patients, Pneumocystis jirovecii, Clostridium difficile in 2 patients, Klebsiella pneumonia in 2 patients, and Streptococcus pneumonia and Hemophilus influenza in 1 patient. Ten patients were treated with antibiotics and immunoglobulin replacement. Only 1 patient who was on immunosuppressant therapy died from P. jirovecii pneumonia.Infection was the most frequent cause for hospitalization of GS patients. Both respiratory and intestinal tracts were the most common sites of infection. Cytomegalovirus and P. jirovecii represented 2 common opportunistic pathogens isolated from hospitalized GS patients with infections.
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Affiliation(s)
- Xuefeng Sun
- From the Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing, China
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11
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Abstract
Good’s syndrome is a relatively rare immunodeficiency condition that presents in the fourth or fifth decade of life and is defined by hypogammaglobulinemia in the setting of a thymoma. The humoral defect may be severe enough to cause an absence in B cells, with a consequent recurrence of sinopulmonary disease, chronic non-infectious diarrhea and opportunistic infections. The prognosis in patients with Good’s syndrome appears to be worse than in those with X-linked agammaglobulinemia (XLA) and common variable immune deficiency (CVID). There have only been three cases of Good’s syndrome associated with mycobacterium, and only one case with a cavitary lesion in the lungs. We present here a unique case of Good’s syndrome with a non-mycobacterial cavitary lesion.
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Affiliation(s)
- Raffi Tachdjian
- Division of Allergy and Clinical Immunology, UCLA School of Medicine, 1301 20th Street, Suite 220, Santa Monica, CA, 90404, USA.
| | - Janet J Keller
- Division of Internal Medicine, Kaiser Permanente, Downey, CA, USA
| | - Michael Pfeffer
- Division of Internal Medicine and Health Services Research, UCLA School of Medicine, Los Angeles, CA, USA
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Akinosoglou K, Melachrinou M, Siagris D, Koletsis E, Marangos M, Gogos CA, Solomou EE. Good's syndrome and pure white cell aplasia complicated by cryptococcus infection: A case report and review of the literature. J Clin Immunol 2014; 34:283-8. [PMID: 24627080 DOI: 10.1007/s10875-014-0014-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/28/2014] [Indexed: 11/27/2022]
Abstract
Thymomas can present with a variety of paraneoplastic manifestations, mostly of autoimmune origin, including Good's syndrome when there is associated hypogammaglobulinemia. Although pure red cell aplasia is a recognised complication of thymoma, selective white cell aplasia is very rare, particularly in Good's syndrome. Lethal opportunistic infections are a feature of Good's syndrome, usually occurring in those patients with associated severe T lymphocyte defects. Although the cryptococcus is a recognised fungal pathogen in patients with other causes of CD4+ T cell lymphopenia, surprisingly this complication has not been reported in patients with Good's syndrome. We now describe a 70 year old man with Good's syndrome and pure white cell aplasia who presented with disseminated cryptococcosis, and provide an up-to-date review of the relevant literature. Despite meningeal involvement our patient recovered after combined treatment with intravenous globulin, granulocyte stimulating growth, corticosteroids and antifungal therapy.
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Affiliation(s)
- K Akinosoglou
- Department of Internal Medicine, 5th floor, University General Hospital of Patras, 26504, Rio, Greece,
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13
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Good Syndrome, a rare cause of refractory chronic diarrhea and recurrent pneumonia in a Chinese patient after thymectomy. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 20:1097-8. [PMID: 23697574 DOI: 10.1128/cvi.00141-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The diagnosis of Good syndrome is very difficult. It has various symptoms, and these symptoms can be present at different periods. In this report we present a patient with refractory chronic diarrhea, recurrent pneumonia, and dysgammaglobulinemia after thymectomy, who was finally then diagnosed with Good syndrome.
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14
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Aydintug YS, Bayar GR, Ozkan A, Gunhan O, Musabak U. Thymoma with immunodeficiency with multiple recurrent oral herpetic infections. J Dent Sci 2012; 11:103-106. [PMID: 30894954 PMCID: PMC6395152 DOI: 10.1016/j.jds.2012.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 10/14/2012] [Indexed: 11/25/2022] Open
Abstract
Thymomas with immunodeficiency (formerly Good's syndrome) are a rare acquired disease of combined T- and B-cell immunodeficiency accompanying a thymoma. Recurrent opportunistic infections associated with disorders of both humoral and cell-mediated immunity frequently accompany this rare primary, adult-onset immunodeficiency. This is a report of a case of a thymoma with immunodeficiency in a 65-year-old male patient who developed recurrent oral herpetic infections. He consulted us about recurrent vesiculo-ulcerative lesions on his tongue, lower lip, and buccal mucosa. Results of laboratory examinations indicated hypogammaglobulinemia accompanied by diminished B cells in the peripheral blood, which is consistent with the characteristic features of a thymoma with immunodeficiency. After a diagnosis confirming herpes simplex virus infection, systemic antiviral therapy was administered, which was effective for his vesiculo-ulcerative lesions at follow-up. When an intractable infection accompanied by a thymoma is encountered, increased awareness about the clinical and immunological profiles of this primary immunodeficiency may help in its early diagnosis, thereby preventing mortality.
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Affiliation(s)
- Yavuz Sinan Aydintug
- Department of Oral and Maxillofacial Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Gurkan Rasit Bayar
- Department of Oral and Maxillofacial Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Aydin Ozkan
- Department of Oral and Maxillofacial Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Omer Gunhan
- Department of Pathology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Ugur Musabak
- Department of Immunology, Gulhane Military Medical Academy, Ankara, Turkey
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15
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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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