Good’s Syndrome Complicated with COVID-19 and Recurrent  Pulmonary Infections: A Case Report

Wenjuan  Xia; Mengqi  Wu; Fang  He

doi:10.18502/ijaai.v25i2.20805

Wenjuan Xia Department of Respiratory and Critical Care Medicine, Anhui Chest Hospital, Hefei, China
Mengqi Wu Department of Respiratory and Critical Care Medicine, Anhui Chest Hospital, Hefei, China
Fang He Department of Respiratory and Critical Care Medicine, Anhui Chest Hospital, Hefei, China

DOI: https://doi.org/10.18502/ijaai.v25i2.20805

Keywords: COVID-19; Good’s syndrome; Hypogammaglobulinemia; Immunodeficiency; Recurrent infections

Abstract

Good’s syndrome (GS), a rare immunodeficiency disorder characterized by thymoma and hypogammaglobulinemia, presents diagnostic and therapeutic challenges due to recurrent infections.

We report a 53-year-old male farmer with GS complicated by recurrent pulmonary infections and COVID-19. Initial management focused on antiviral/anti-infective therapy and corticosteroids, but persistent hypogammaglobulinemia, B-cell depletion, and thymoma history were overlooked.

Diagnosis was confirmed upon integrating the thymoma history, immunological profiling, and bronchial alveolar lavage-next generation sequencing, revealing Pneumocystis jirovecii and Herpes Simplex Virus-1 coinfections. Treatment with intravenous immunoglobulin loading dose (2 g/kg), pathogen-targeted therapy (voriconazole, cotrimoxazole), and tapered corticosteroids achieved clinical remission, with immunoglobulin G (IgG) elevating to 6.35 g/L.

This case underscores the necessity of a "four-dimensional early warning system" integrating thymoma history, immune, imaging, and pathogen for timely GS diagnosis. Multidisciplinary collaboration and personalized regimens combining immunoglobulin replacement, precision anti-infectives, and immunomodulation are pivotal for optimizing outcomes in GS patients with complex infections.