Good’s Syndrome Complicated with COVID-19 and Recurrent Pulmonary Infections: A Case Report
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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.
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15. Tachdjian R, Keller JJ, Pfeffer M. A Bad Case of Good’s Syndrome. Infect Dis Ther. 2014;3(2):333-7.
16. Jensen ML, Bendstrup E, Hilberg O. Granulomatous-lymphocytic interstitial lung disease and recurrent sinopulmonary infections in a patient with Good’s syndrome. BMJ Case Rep. 2015;2015.
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18. Shi Y, Wang C. When the Good Syndrome Goes Bad: A Systematic Literature Review. Front Immunol. 2021;12:679556.
19. Tolomeo M, Bonura S, Abbott M, Anastasia A, Colomba C, Cascio A. Good’s syndrome and recurrent leishmaniasis: A case report and review of literature. Heliyon. 2020;6(9):e05061.
20. Luque-Luna M, Alamon-Reig F, Iranzo-Fernández P. Oral lichenoid lesions as a sign of Good’s syndrome. Int J Dermatol. 2022;61(9):e345-e6.
21. Diao B, Wang C, Tan Y, Chen X, Liu Y, Ning L, et al. Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19). Front Immunol. 2020;11:827.
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24. Cos Esquius ML, López Montesinos I, Gimeno Martinez R, Eguía Núñez J, Caballero-Rabasco MA, Sánchez González B, et al. Severe COVID-19 pneumonia in Good syndrome with a favorable outcome. Clin Immunol. 2022;235:108789.
25. Maldonado-Domínguez ED, O Farrill-Romanillos PM. Paciente con síndrome de Good y COVID-19. Reporte de un caso clínico. Revista Médica del Instituto Mexicano del Seguro Social. 2022;60:474 - 9.
26. Wee LE, Tan JY, Oon LLE, Pena AMT, Quek JKS, Venkatachalam I, et al. Relapsing COVID-19 infection as a manifestation of Good syndrome: a case report and literature review. Int J Infect Dis. 2023;129:236-9.
27. Pasula S, Vijayan R. Herpes Simplex Virus (HSV) Pneumonitis as a Late Complication of COVID-19 Infection: A Unique Case Report. Cureus. 2025;17(2):e79228.
28. Jeican, II, Inișca P, Gheban D, Tăbăran F, Aluaș M, Trombitas V, et al. COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection First Case Confirmed through Autopsy. Medicina (Kaunas). 2021;57(4).
29. Wang H, Zhao B. Diagnostic value of bronchoalveolar lavage fluid metagenomic next-generation sequencing for pulmonary infections in patients with connective tissue disease: A retrospective study. Sci Rep. 2025;15(1):20042.
30. Nath P, Kabir MA, Doust SK, Ray A. Diagnosis of Herpes Simplex Virus: Laboratory and Point-of-Care Techniques. Infect Dis Rep. 2021;13(2):518-39.
31. Berzenji L, Yogeswaran SK, Snoeckx A, Van Schil PE, Wener R, Hendriks JMH. Good’s syndrome and COVID-19: case report and literature review. Mediastinum. 2023;7:5.
32. Turaes AS, Alharbi WK, Alqurashi RK, Touman A, Bulkhi A. Persistent Fever and Cough in a Patient With Good’s Syndrome: A Case Report. Cureus. 2022;14(5):e24996.
33. Kwok CT, Yeung YC. Good’s syndrome presenting with CMV pneumonitis and oesophageal candidiasis: A case report. Respirol Case Rep. 2022;10(1):e0888.
34. Yıldırım İ, Topyıldız E, Bilgin RBG, Aykut A, Durmaz A, Edeer Karaca N, et al. X-linked agammaglobulinemia: ınvestigation of clinical and laboratory findings, novel gene mutations and prevention of ınfective complications in long-term follow-up. Am J Clin Exp Immunol. 2021;10(1):37-43.
35. Lee TK, Gereige JD, Maglione PJ. State-of-the-art diagnostic evaluation of common variable immunodeficiency. Ann Allergy Asthma Immunol. 2021;127(1):19-27.
2. Sipos F, Műzes G. Good’s syndrome: brief overview of an enigmatic immune deficiency. Apmis. 2023;131(12):698-704.
3. Kabir A, Alizadehfar R, Tsoukas CM. Good’s Syndrome: Time to Move on From Reviewing the Past. Front Immunol. 2021;12:815710.
4. Ren S, Hu Y, Xiao Y, Zong D, Peng Y, Liu Q, et al. Good’s syndrome combined with bronchiectasis: A case report and literature review. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021;46(3):328-32.
5. Koo CW, Lo YC. Good’s Syndrome: Thymoma with Acquired Immunodeficiency. Am J Respir Crit Care Med. 2023;208(3):322-4.
6. Chen J, Yang Y, Zhu D, Chen G, Wei S, Qiu X, et al. Thymoma with pure red cell aplasia and Good’s syndrome. Ann Thorac Surg. 2011;91(5):1620-2.
7. Mathew A, Chengappa KG. Good’s syndrome: Thymoma with hypogammaglobulinaemia. Indian J Med Res. 2020;152(Suppl 1):S209.
8. 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(13):1604-9.
9. Okusu T, Sato T, Ogata Y, Nagata S, Kozumi K, Kim SH, et al. Good’s Syndrome Accompanied by Agranulocytosis Following a Rapid Clinical Course. Intern Med. 2016;55(5):537-40.
10. Akinosoglou K, Melachrinou M, Siagris D, Koletsis E, Marangos M, Gogos CA, et al. 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(3):283-8.
11. 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(1):50.
12. Duarte M, Faria L, Patronillo C, da Costa Fernandes S, Seara V. A Case of Severe COVID-19 in a Patient with Good’s Syndrome. Eur J Case Rep Intern Med. 2021;8(10):002976.
13. Tamburello A, Castelnovo L, Faggioli P, Bompane D, Brando B, Gatti A, et al. Good’s syndrome, a rare form of acquired immunodeficiency associated with thymomas. Clin Pract. 2019;9(2):1112.
14. Paganelli R, Di Lizia M, D’Urbano M, Gatta A, Paganelli A, Amerio P, et al. Insights from a Case of Good’s Syndrome (Immunodeficiency with Thymoma). Biomedicines. 2023;11(6).
15. Tachdjian R, Keller JJ, Pfeffer M. A Bad Case of Good’s Syndrome. Infect Dis Ther. 2014;3(2):333-7.
16. Jensen ML, Bendstrup E, Hilberg O. Granulomatous-lymphocytic interstitial lung disease and recurrent sinopulmonary infections in a patient with Good’s syndrome. BMJ Case Rep. 2015;2015.
17. Műzes G, Sipos F. [Good syndrome: a rare, unusual immunodeficiency condition]. Orv Hetil. 2023;164(22):859-63.
18. Shi Y, Wang C. When the Good Syndrome Goes Bad: A Systematic Literature Review. Front Immunol. 2021;12:679556.
19. Tolomeo M, Bonura S, Abbott M, Anastasia A, Colomba C, Cascio A. Good’s syndrome and recurrent leishmaniasis: A case report and review of literature. Heliyon. 2020;6(9):e05061.
20. Luque-Luna M, Alamon-Reig F, Iranzo-Fernández P. Oral lichenoid lesions as a sign of Good’s syndrome. Int J Dermatol. 2022;61(9):e345-e6.
21. Diao B, Wang C, Tan Y, Chen X, Liu Y, Ning L, et al. Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19). Front Immunol. 2020;11:827.
22. Gur I, Giladi A, Isenberg YN, Neuberger A, Stern A. COVID-19 in Patients with Hematologic Malignancies: Clinical Manifestations, Persistence, and Immune Response. Acta Haematol. 2022;145(3):297-309.
23. Pietroluongo E, Peddio A, De Placido P, Tortora M, Ottaviano M, Gelzo M, et al. COVID-19 in patients with thymic epithelial tumors with or without Good’s syndrome: a single-center retrospective study. BMC Cancer. 2024;24(1):748.
24. Cos Esquius ML, López Montesinos I, Gimeno Martinez R, Eguía Núñez J, Caballero-Rabasco MA, Sánchez González B, et al. Severe COVID-19 pneumonia in Good syndrome with a favorable outcome. Clin Immunol. 2022;235:108789.
25. Maldonado-Domínguez ED, O Farrill-Romanillos PM. Paciente con síndrome de Good y COVID-19. Reporte de un caso clínico. Revista Médica del Instituto Mexicano del Seguro Social. 2022;60:474 - 9.
26. Wee LE, Tan JY, Oon LLE, Pena AMT, Quek JKS, Venkatachalam I, et al. Relapsing COVID-19 infection as a manifestation of Good syndrome: a case report and literature review. Int J Infect Dis. 2023;129:236-9.
27. Pasula S, Vijayan R. Herpes Simplex Virus (HSV) Pneumonitis as a Late Complication of COVID-19 Infection: A Unique Case Report. Cureus. 2025;17(2):e79228.
28. Jeican, II, Inișca P, Gheban D, Tăbăran F, Aluaș M, Trombitas V, et al. COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection First Case Confirmed through Autopsy. Medicina (Kaunas). 2021;57(4).
29. Wang H, Zhao B. Diagnostic value of bronchoalveolar lavage fluid metagenomic next-generation sequencing for pulmonary infections in patients with connective tissue disease: A retrospective study. Sci Rep. 2025;15(1):20042.
30. Nath P, Kabir MA, Doust SK, Ray A. Diagnosis of Herpes Simplex Virus: Laboratory and Point-of-Care Techniques. Infect Dis Rep. 2021;13(2):518-39.
31. Berzenji L, Yogeswaran SK, Snoeckx A, Van Schil PE, Wener R, Hendriks JMH. Good’s syndrome and COVID-19: case report and literature review. Mediastinum. 2023;7:5.
32. Turaes AS, Alharbi WK, Alqurashi RK, Touman A, Bulkhi A. Persistent Fever and Cough in a Patient With Good’s Syndrome: A Case Report. Cureus. 2022;14(5):e24996.
33. Kwok CT, Yeung YC. Good’s syndrome presenting with CMV pneumonitis and oesophageal candidiasis: A case report. Respirol Case Rep. 2022;10(1):e0888.
34. Yıldırım İ, Topyıldız E, Bilgin RBG, Aykut A, Durmaz A, Edeer Karaca N, et al. X-linked agammaglobulinemia: ınvestigation of clinical and laboratory findings, novel gene mutations and prevention of ınfective complications in long-term follow-up. Am J Clin Exp Immunol. 2021;10(1):37-43.
35. Lee TK, Gereige JD, Maglione PJ. State-of-the-art diagnostic evaluation of common variable immunodeficiency. Ann Allergy Asthma Immunol. 2021;127(1):19-27.
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| COVID-19 Good’s syndrome Hypogammaglobulinemia Immunodeficiency Recurrent infections | ||
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How to Cite
1.
Xia W, Wu M, He F. Good’s Syndrome Complicated with COVID-19 and Recurrent Pulmonary Infections: A Case Report. Iran J Allergy Asthma Immunol. 2025;:1-10.
