Good Syndrome Presenting With Pulmonary Abnormalities Four Years After Thymectomy

Good syndrome is a rare immunodeficiency associated with thymoma, characterized by hypogammaglobulinemia and marked B-cell depletion. A 72-year-old woman who had undergone thymectomy 4 years earlier was referred to our hospital due to recurrent respiratory infections. Chest computed tomography revealed patchy ground-glass opacities without evidence of thymoma recurrence. Bronchoalveolar lavage showed lymphocytosis, suggesting that the pulmonary abnormalities had possible inflammatory features, although infection could not be fully excluded. A short course of corticosteroids was added to empiric antibiotic therapy with careful monitoring, and the respiratory symptoms and radiological abnormalities improved after treatment. Because of her history of thymoma, further immunologic evaluation was performed and revealed profound hypogammaglobulinemia with near absence of peripheral B cells, leading to a diagnosis of Good syndrome. Intravenous immunoglobulin therapy was initiated, resulting in an increase in serum IgG levels and prevention of further respiratory infections. This case highlights that Good syndrome may become clinically apparent years after thymectomy and should be considered in patients with recurrent respiratory infections and unexplained pulmonary abnormalities.