Background and Aims

Good Syndrome, report of two cases.

The GS (Thymoma and Serum IgG decrease by two standard deviations below the mean for age.) accounts for 0.2% of immune deficiencies; it affects the population between the 4^th and 5^th decades of life.

Hypogammaglobulinemia occurs as paraneoplastic syndrome in 5-10% of all thymomas. GS clinical manifestations include symptoms such as dysphagia, chest oppression, chronic cough and superior vena cava syndrome; recurrent sinopulmonary, urinary tract, gastrointestinal or skin infections.

In 30% of cases, GS coexists with autoimmunity. GS treatment includes thymectomy and human gammaglobulin every 3-4 weeks.

Methods

Case 1: 47-year-old male patient with a history of chronic sinusitis, history of tinea corporis with torpid evolution, chronic cough and dyspnea. On diagnostic workup, an anterior mediastinal tumor was found. The patient underwent surgical resection. Six months later, he presented with urinary sepsis with no isolated germs, and blood culture positive for Morganella morganii, accompanied by reactive arthritis and hypogammaglobulinemia. The patient was started on intravenous immunoglobulin with clinical improvement.

Results

Case 2: 78-year-old female patient with a history of pneumonia, candidiasis, oral lichen planus and bronchiectasis. She had undergone a chest CT scan to evaluate symptoms of dyspnea, with an anterior mediastinal tumor. Surgical resection was practiced. Her laboratory tests reported hypogammaglobulinemia. She was started on intravenous gammaglobulin with clinical improvement.

Conclusions

Good syndrome should be considered in all patients with thymoma, even in the absence of symptoms or after surgical resection. An opportune diagnosis will impact on quality of life and prognosis.