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Tabarsi P, Hemmatian M, Moradi M. Long COVID-19 leading to Good's syndrome diagnosis: A clinical case-report and literature review. Clin Case Rep 2024; 12:e8962. [PMID: 38808198 PMCID: PMC11130229 DOI: 10.1002/ccr3.8962] [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: 02/16/2024] [Revised: 03/20/2024] [Accepted: 04/12/2024] [Indexed: 05/30/2024] Open
Abstract
Key Clinical Message Good's syndrome (GS) in conjunction with a severe COVID-19 infection, shedding light on the complexities of managing this rare condition that combines thymoma and immunodeficiency. Abstract This study delves into the clinical presentation and management of a 63-year-old male diagnosed with Good's syndrome (GS) amid a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. GS, an uncommon association between thymoma and immunodeficiency, remains a clinical mystery, necessitating increased awareness and understanding. Our patient's intricate clinical course, marked by recurrent COVID-19 symptoms and multiple hospitalizations, exemplifies the challenges posed by GS. Through a systematic review of GS cases globally, we highlight its worldwide distribution, with a substantial proportion reported in Europe. Notably, the diagnosis of thymoma often precedes immunodeficiency, emphasizing the importance of vigilance in clinical assessments.
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Affiliation(s)
- Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute for Tuberculosis and Lung Disease (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Marjan Hemmatian
- Infectious Diseases and Tropical Medicine, Loghman Hospital, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Maryam Moradi
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram HospitalIran University of Medical SciencesTehranIran
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Ishizuchi K, Takizawa T, Ohnuki Y, Sekiguchi K, Motegi H, Oyama M, Nakahara J, Shiina T, Suzuki S. Immunodeficiency in patients with thymoma-associated myasthenia gravis. J Neuroimmunol 2022; 371:577950. [PMID: 35994947 DOI: 10.1016/j.jneuroim.2022.577950] [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: 06/07/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022]
Abstract
Thymoma with immunodeficiency is sometimes accompanied by myasthenia gravis (MG), but the clinical characteristics have not been elucidated. This study aimed to characterize its clinical and immunological features. Of the 132 thymoma-associated MG patients, 9 patients presented with immunodeficiency. All suffered from severe pneumonia, and most had invasive thymoma and autoimmune disorders. DRB1*08:03 and DQB1*06:01 alleles were frequently detected. Compared to group without immunodeficiency, they showed no significant differences in the severity of MG, significantly lower IgG concentrations and higher mortality rate. Thymoma-associated MG with immunodeficiency is a distinct subset requiring special attention to prevent infection during the follow-up period.
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Affiliation(s)
- Kei Ishizuchi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
| | - Yuko Ohnuki
- Department of Medical Ethics, Tokai University School of Medicine, Kanagawa, Japan; Department of Clinical Genetics, Tokai University School of Medicine, Kanagawa, Japan.
| | - Koji Sekiguchi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
| | - Haruhiko Motegi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan; Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Munenori Oyama
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
| | - Takashi Shiina
- Department of Molecular Life Science, Tokai University School of Medicine, Kanagawa, Japan.
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
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Rey M, Rico D, López Panqueva RDP, Vásquez Roldán M. Apoptotic collopathy as a manifestation of Good's syndrome. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 114:115-116. [PMID: 34488419 DOI: 10.17235/reed.2021.8297/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
44-year-old patient with 4 years of evolution of recurrent respiratory infections, fever, weight loss of 30 kg and chronic diarrhea with inconclusive colonoscopy studies managed as IBD (inflammatory bowel disease). A colonoscopy was performed with an infectious aspect vs IBD, the biopsies revealed acute colitis with cryptic apoptosis without evidence of chronicity. So is considered another type of immunodeficiency with the presence of hypogammaglobulinemia, reaching the diagnosis of Good's syndrome due to the association with thymoma and recurrent infections.
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Affiliation(s)
- Margarita Rey
- Gastroenterology and Hepatology, Fundación Santa fe de Bogotá, Colombia
| | - Daniela Rico
- Internal Medicine, Fundación Santa Fe de Bogotá , Colombia
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Rodriguez JA, Bang TJ, Restrepo CS, Green DB, Browne LP, Vargas D. Imaging Features of Primary Immunodeficiency Disorders. Radiol Cardiothorac Imaging 2021; 3:e200418. [PMID: 33969305 PMCID: PMC8098094 DOI: 10.1148/ryct.2021200418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Primary immunodeficiency disorders (PIDs), which are humoral, combined, and innate defects of the immune system, are relatively uncommon and may go undiagnosed in patients experiencing recurrent infections, resulting in increased morbidity and mortality. PIDs are clinically characterized by a broad spectrum of disorders, including repeated infections, autoimmune disorders, lymphoproliferative diseases, congenital anomalies, and increased risk of malignancy. Cardiothoracic imaging plays a crucial role in the diagnosis of PIDs owing to the high rates of repeated respiratory infections leading to bronchiectasis and other forms of chronic lung disease. Although PIDs as a group may seem similar in terms of radiologic features and clinical manifestations, there are specific entities that are pertinent to each PID on an individual level. For example, patients with common variable immunodeficiency may develop a unique granulomatous lymphocytic interstitial lung disease, and Good syndrome is associated with thymoma. Familiarity with the imaging characteristics of these disorders may expedite diagnosis and prognostication, and better direct therapy. Reviewing the thoracic manifestations of all PIDs is beyond the scope of this article; thus, the focus herein is on discussing the thoracic manifestations of the most common PIDs and their imaging features. © RSNA, 2021An earlier incorrect version appeared online. This article was corrected on March 25, 2021.
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Li Y, Yao Z, Jiang M, Nie Y, Chen R, Liang N, Yang H, Zhang X, Zhang F. Clinical manifestations and long-term prognosis of Good syndrome: Results from a single-center cohort study from China. Mod Rheumatol 2021; 31:1019-1024. [PMID: 33428506 DOI: 10.1080/14397595.2020.1868735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe clinical features and long-term prognosis in patients with Good syndrome (GS). METHODS We retrospectively reviewed medical records of GS patients at Peking Union Medical College Hospital from January 2001 to May 2019. Data regarding clinical manifestations and treatments were collected. Patients were routinely followed-up via clinical and telephone interviews, and survival analysis was performed with Kaplan-Meier analysis. RESULTS Twenty-four patients were identified, including eight males and 16 females, with a median age at diagnosis of 58 years (interquartile range [IQR], 52-62 years). Twelve patients (50%) had autoimmune manifestations. Multi-organ involvements included musculoskeletal (37.5%), respiratory (33.3%), gastrointestinal (29.2%), hematologic (29.2%) systems, et.al. Infections were detected in 23 (95.8%) patients, mostly located in lung (69.6%), blood (26.1%), and gastrointestinal tract (21.7%). Thymectomy was performed in 23 patients, with the most common histology of type AB (10, 47.6%). Twenty-one patients were consecutively followed-up with a median follow-up of 84 (IQR, 48-116) months and 11 (52.4%) died, mainly due to infection (8/11, 72.7%). The 5- and 10-year survival rates were 90% (95% confidence interval [CI], 77.8-100%) and 38.5% (95% CI, 19.6-75.5%), respectively. CONCLUSION GS patients tended to present with various infections and autoimmune manifestations. The 10-year survival rate from the Chinese population was poor, mainly due to infections.
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Affiliation(s)
- Yueting Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, China.,Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Zhuoran Yao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, China.,Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengdi Jiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, China.,Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Yuxue Nie
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, China.,Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Ruxuan Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, China.,Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Naixin Liang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huaxia Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, China.,Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Xuan Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, China.,Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, The Ministry of Education Key Laboratory, Beijing, China.,Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
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Chastagner M, Durupt F, Hicks J, Bruyas A, Sève P, Jamilloux Y. Kaposi's sarcoma associated with Good syndrome. Med Mal Infect 2020; 50:752-754. [PMID: 32777359 DOI: 10.1016/j.medmal.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/31/2020] [Indexed: 01/20/2023]
Affiliation(s)
- M Chastagner
- Department of Dermatology, hospices civils de Lyon, hôpital Lyon Sud, université Claude-Bernard-Lyon 1, Lyon, France
| | - F Durupt
- Department of Dermatology, hospices civils de Lyon, groupement hospitalier Nord, université Claude-Bernard-Lyon 1, Lyon, France
| | - J Hicks
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - A Bruyas
- Department of Oncology, hospices civils de Lyon, groupement hospitalier Nord, université Claude-Bernard-Lyon 1, Lyon, France
| | - P Sève
- Department of Internal Medicine, hospices civils de Lyon, groupement hospitalier Nord, université Claude-Bernard-Lyon 1, Lyon, France
| | - Y Jamilloux
- Department of Internal Medicine, hospices civils de Lyon, groupement hospitalier Nord, université Claude-Bernard-Lyon 1, Lyon, France.
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Rajan A, Zhao C. Deciphering the biology of thymic epithelial tumors. MEDIASTINUM (HONG KONG, CHINA) 2019; 3:36. [PMID: 31608319 PMCID: PMC6788633 DOI: 10.21037/med.2019.08.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/11/2019] [Indexed: 12/25/2022]
Abstract
Thymic cancers arise from epithelial cells of the thymus and have a predilection for intrathoracic spread. Clinical behavior varies from relatively indolent to highly aggressive with a capacity to metastasize widely and adversely affect survival. Paraneoplastic autoimmune disorders are frequently observed in association with thymoma and have a significant impact on quality of life. Underlying immune deficits associated with thymic epithelial tumors (TETs) increase the risk for development of opportunistic infections and emergence of extrathymic malignancies. Advances in the molecular characterization of thymic tumors have revealed the lowest tumor mutation burden among all adult cancers and the occurrence of distinct molecular subtypes of these diseases. Mutations in general transcription factor IIi (GTF2I) are unique to TETs and are rarely observed in other malignancies. The infrequency of actionable mutations has created obstacles for the development of biologic therapies and has spurred research to uncover druggable genomic targets. Persistence of autoreactive T cells due to altered thymic function increases the risk for development of severe immune-related toxicity and limits opportunities for use of immune-based therapies, especially in patients with thymoma. In this paper we review emerging data on the molecular characterization and immunobiology of thymic tumors and highlight clinical implications of these discoveries.
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Affiliation(s)
- Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Chen Zhao
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Gernez Y, Baker MG, Maglione PJ. Humoral immunodeficiencies: conferred risk of infections and benefits of immunoglobulin replacement therapy. Transfusion 2019; 58 Suppl 3:3056-3064. [PMID: 30536429 PMCID: PMC6939302 DOI: 10.1111/trf.15020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023]
Abstract
Primary immunodeficiency (PID) diseases result from genetic defects of the immune system that increase a patient's susceptibility to infections. The types of infections that occur in patients with PID diseases are dictated largely by the nature of the immunodeficiency, which can be defined by dysfunction of cellular or humoral defenses. An increasing number of PID diseases, including those with both cellular and humoral defects, have antibody deficiency as a major feature, and as a result can benefit from immunoglobulin replacement therapy. In fact, the most common PID diseases worldwide are antibody deficiencies and include common variable immunodeficiency, congenital agammaglobulinemia, hyper‐IgM syndrome, specific antibody deficiency, and Good syndrome. Although immunoglobulin replacement therapy is the cornerstone of treatment for the majority of these conditions, a thorough understanding of the specific infections for which these patients are at increased risk can hasten diagnosis and guide additional therapies. Moreover, the infection trends in some patients with PID disease who have profound defects of cellular immunity, such as autosomal‐dominant hyper‐IgE syndrome (Job/Buckley syndrome) or dedicator of cytokinesis 8 (DOCK8) deficiency, suggest that select patients might benefit from immunoglobulin replacement therapy even if their immunodeficiency is not limited to antibody defects. In this review, we provide an overview of the predisposition to infections seen in PID disease that may benefit from immunoglobulin replacement therapy.
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Affiliation(s)
- Yael Gernez
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Mary Grace Baker
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul J Maglione
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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