Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 25 2 2026 02 01 269 278 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 2025 05 06 2025 07 02 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. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4430 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4430/2231