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Koning MT, van Rossum AP, Tiren-Verbeet NL, Burgers JA, Karim AF. Two Independent Hematological malignancies in a B-Cell Deficient Good Syndrome Patient. Rheumatology (Oxford) 2021; 60:e126-e128. [PMID: 33188420 PMCID: PMC8023981 DOI: 10.1093/rheumatology/keaa666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/28/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marvyn T Koning
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - André P van Rossum
- Laboratory for Clinical Chemistry and Hematology, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | | | - Jacobus A Burgers
- Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A Faiz Karim
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Groene Hart Ziekenhuis, Gouda, The Netherlands
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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:e05061. [PMID: 33024862 PMCID: PMC7527582 DOI: 10.1016/j.heliyon.2020.e05061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/08/2020] [Accepted: 09/17/2020] [Indexed: 10/26/2022] Open
Abstract
We report the case of a 56-year-old Caucasian male affected by thymoma and myasthenia gravis that developed recurrent visceral leishmaniasis 11 years after thymectomy. After treatment of each relapse with liposomal amphotericin B the PCR-Leishmania was negative and the patient showed clinical improvement. An immunologic work-up was performed showing lymphopenia with an important decrease in CD4+ T cells (52 cells/μ) and CD4/CD8 ratio (0.2). HIV test was negative. On the basis of previous thymoma and myasthenia gravis and on the basis of the immunological profile a diagnosis of Good's syndrome was made. Since IFNγ plays a main role in the control of Leishmania infection the production of IFNγ was evaluated. After mitogen stimulation of peripheral blood mononuclear cells the production of IFNγ was lower than normal. This is the second reported case of Good's syndrome with recurrent leishmaniasis and indicates that a definitive cure for leishmaniasis in patients with Good's syndrome is not possible. Immunologic work-up in our patient strongly suggests that relapses could be correlated with the low CD4+ T cell number and with the low IFNγ production. Immunotherapy with IFNγ or with compounds able to block the Th2 interleukin production could be a therapeutic option in these patients.
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Affiliation(s)
- Manlio Tolomeo
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Silvia Bonura
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Michelle Abbott
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Antonio Anastasia
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Claudia Colomba
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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Multani A, Gomez CA, Montoya JG. Prevention of infectious diseases in patients with Good syndrome. Curr Opin Infect Dis 2019; 31:267-277. [PMID: 29878906 DOI: 10.1097/qco.0000000000000473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Good syndrome is a profoundly immunocompromising condition with heterogeneous immune deficits characterized by the presence of thymoma, low-to-absent B-lymphocyte counts, hypogammaglobulinemia, and impaired cell-mediated immunity. Opportunistic infectious diseases associated with Good syndrome represent a diagnostic and therapeutic challenge, given their protean clinical manifestations. Although these infectious complications have been reviewed in prior publications, recommendations regarding their prevention have been lacking. RECENT FINDINGS Good syndrome usually occurs in adult patients between the ages of 40 and 70 years. Immunologically, it is characterized by low or absent peripheral blood B lymphocytes, hypogammaglobulinemia, and variable defects in cell-mediated immunity including low CD4 T counts, inverted CD4:CD8 T-lymphocyte ratio, and reduced T-lymphocyte mitogen proliferative responses. Patients with Good syndrome are susceptible to a variety of infectious diseases, of which the most common are recurrent bacterial sinopulmonary infections, mucocutaneous candidiasis, and CMV tissue-invasive disease. Preventive guidelines including targeted antimicrobial prophylaxis and vaccination strategies can mitigate infectious complications in patients with Good syndrome. SUMMARY Immunological deficits and infectious complications in Good syndrome have been described for over 60 years. Further research is needed to elucidate its exact pathogenesis and define the mechanistic relationship between thymoma and hypogammaglobulinemia. However, tailored prophylactic strategies can be recommended for patients with Good syndrome.
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Affiliation(s)
- Ashrit Multani
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine.,Palo Alto Medical Foundation, Toxoplasma Serology Laboratory (PAMF-TSL), National Reference Center for the Study and Diagnosis of Toxoplasmosis, Palo Alto, California, USA
| | - Carlos A Gomez
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine.,Palo Alto Medical Foundation, Toxoplasma Serology Laboratory (PAMF-TSL), National Reference Center for the Study and Diagnosis of Toxoplasmosis, Palo Alto, California, USA
| | - José G Montoya
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine.,Palo Alto Medical Foundation, Toxoplasma Serology Laboratory (PAMF-TSL), National Reference Center for the Study and Diagnosis of Toxoplasmosis, Palo Alto, California, USA
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Mahdaviani SA, Rezaei N. Pulmonary Manifestations of Predominantly Antibody Deficiencies. PULMONARY MANIFESTATIONS OF PRIMARY IMMUNODEFICIENCY DISEASES 2019. [PMCID: PMC7123456 DOI: 10.1007/978-3-030-00880-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Predominantly antibody deficiencies (PADs) are the most frequent forms of primary immunodeficiency diseases (PIDs). Commonly accompanied with complications involving several body systems, immunoglobulin substitution therapy along with prophylactic antibiotics remained the cornerstone of treatment for PADs and related complications. Patients with respiratory complications should be prescribed an appropriate therapy as soon as possible and have to be adhering to more and longer medical therapies. Recent studies identified a gap for screening protocols to monitor respiratory manifestations in patients with PADs. In the present chapter, the pulmonary manifestations of different PADs for each have been discussed. The chapter is mainly focused on X-linked agammaglobulinemia, common variable immunodeficiency, activated PI3K-δ syndrome, LRBA deficiency, CD19 complex deficiencies, CD20 deficiency, other monogenic defects associated with hypogammaglobulinemia, immunoglobulin class switch recombination deficiencies affecting B-cells, transient hypogammaglobulinemia of infancy, and selective IgA deficiency.
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Affiliation(s)
- Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies Children’s Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Caperton C, Agrawal S, Gupta S. Good syndrome presenting with CD8⁺ T-Cell large granular lymphocyte leukemia. Oncotarget 2017; 6:36577-86. [PMID: 26429871 PMCID: PMC4742196 DOI: 10.18632/oncotarget.5369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/17/2015] [Indexed: 12/16/2022] Open
Abstract
Good Syndrome is an adult-onset combined immunodeficiency defined by hypogammaglobulinemia, low or absent number of B cells, T cell deficiency and thymic tumor. We have characterized CD8+ T cells from a patient with Good syndrome that presented with CD8+T-cell large granular lymphocytic leukemia (LGL). Characterization of peripheral blood CD8+ T cells revealed that majority of CD8+ T cells were terminally differentiated effector memory phenotype (TEMRA; CD8+CCR7-CD45RA+), and were PD-1high (CD279), ICOSlow (CD278), and granzymehigh. Almost all CD8+ T cells were IFN-γ+. CD8 Treg (CD8+CD183+CCR7+CD45RA-) were decreased. TEMRA phenotype along with CD279high, demonstrates that these are exhausted CD8+ T cells. This phenotype along with CD278low may also explain severe T cell functional deficiency in our patient. In the present patient, T-LGL appears to be a clonal expansion of CD279+granzyme+IFN-γ+CD8+TEMRA cells. To best of our knowledge this is the first case of CD8+T-cell LGL leukemia associated with Good syndrome.
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Affiliation(s)
- Caroline Caperton
- Program in Primary Immunodeficiency and Aging, Division of Basic and Clinical Immunology, University of California at Irvine, Irvine, California, USA
| | - Sudhanshu Agrawal
- Program in Primary Immunodeficiency and Aging, Division of Basic and Clinical Immunology, University of California at Irvine, Irvine, California, USA
| | - Sudhir Gupta
- Program in Primary Immunodeficiency and Aging, Division of Basic and Clinical Immunology, University of California at Irvine, Irvine, California, USA
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Akinosoglou K, Melachrinou M, Siagris D, Koletsis E, Marangos M, Gogos CA, Solomou EE. Good's syndrome and pure white cell aplasia complicated by cryptococcus infection: A case report and review of the literature. J Clin Immunol 2014; 34:283-8. [PMID: 24627080 DOI: 10.1007/s10875-014-0014-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/28/2014] [Indexed: 11/27/2022]
Abstract
Thymomas can present with a variety of paraneoplastic manifestations, mostly of autoimmune origin, including Good's syndrome when there is associated hypogammaglobulinemia. Although pure red cell aplasia is a recognised complication of thymoma, selective white cell aplasia is very rare, particularly in Good's syndrome. Lethal opportunistic infections are a feature of Good's syndrome, usually occurring in those patients with associated severe T lymphocyte defects. Although the cryptococcus is a recognised fungal pathogen in patients with other causes of CD4+ T cell lymphopenia, surprisingly this complication has not been reported in patients with Good's syndrome. We now describe a 70 year old man with Good's syndrome and pure white cell aplasia who presented with disseminated cryptococcosis, and provide an up-to-date review of the relevant literature. Despite meningeal involvement our patient recovered after combined treatment with intravenous globulin, granulocyte stimulating growth, corticosteroids and antifungal therapy.
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Affiliation(s)
- K Akinosoglou
- Department of Internal Medicine, 5th floor, University General Hospital of Patras, 26504, Rio, Greece,
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Oehler E, Heuberger L, Ghawche F, Valour F. Good's syndrome and IgA monoclonal gammopathy of undetermined significance. BMJ Case Rep 2012. [PMID: 23188874 DOI: 10.1136/bcr-2012-007601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Characterised by the association of a thymoma, hypogammaglobulinaemia, and B-cell and T-cell dysfunction, Good's syndrome (GS) is a rare cause of adult immunodeficiency leading to recurrent infections, and autoimmune manifestations related to the thymoma. We describe a 70-year-old woman in whom the diagnosis of GS was made after 7 years follow-up of a monoclonal gammopathy of undetermined significance (MGUS). After thymectomy, she received monthly intravenous immunoglobulin perfusions in order to maintain a normal plasmatic IgG level. To our knowledge, this is the fifth described case of GS associated with an MGUS. This rare condition should not be misdiagnosed, as the prognosis is determined by infectious and autoimmune complications, which could be prevented.
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Affiliation(s)
- Erwan Oehler
- Department of Médecine Interne, CHPF, Pirae, French Polynesia
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Kelesidis T, Yang O. Good's syndrome remains a mystery after 55 years: A systematic review of the scientific evidence. Clin Immunol 2010; 135:347-63. [PMID: 20149753 DOI: 10.1016/j.clim.2010.01.006] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 01/17/2010] [Indexed: 11/17/2022]
Abstract
Good syndrome (GS) is a rare association of thymoma and immunodeficiency first described more than 50 years ago. However, this syndrome still remains a mystery to clinicians. We systematically reviewed all the clinical, laboratory and immunologic findings from 152 patients with Good syndrome. The syndrome has a worldwide distribution and approximately half of the cases (47%) have been described in Europe. The diagnosis of thymoma preceded the diagnosis of hypogammaglobulinemia, infection, or diarrhea in 42% of patients whereas in 38% of patients the diagnoses were made almost simultaneously within 2 months of each other. We found significant mortality in patients with this syndrome (44.5%). Astute clinical acumen and increased awareness about the clinical and immunological profile of this syndrome may increase early recognition of this syndrome and prevent mortality. Further studies are needed to elucidate this clinical entity.
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Affiliation(s)
- Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Miyakis S, Pefanis A, Passam FH, Christodulakis GR, Roussou PA, Mountokalakis TD. Thymoma with immunodeficiency (Good's syndrome): review of the literature apropos three cases. ACTA ACUST UNITED AC 2006; 38:314-9. [PMID: 16718939 DOI: 10.1080/00365540500372663] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Good's syndrome is the association of thymoma with immunodeficiency, characterized by hypogammaglobulinaemia, depleted B-cells, diminished T-cells and inversion of the CD4/CD8 ratio. The initial clinical presentation is either with a mass lesion-thymoma that is usually benign, or with recurrent infections due to immunodeficiency. Thymectomy usually favourably affects associated conditions, such as pure red cell aplasia, but does not improve hypogammaglobulinaemia, thus the patient remains dependent on intravenous immune globulin and prone to infections. Infections usually affect the respiratory and/or the gastrointestinal tract. Common respiratory, opportunistic, and eventually life-threatening infections may occur. Moreover, patients with Good's syndrome may present other haematological conditions. We report 3 cases with long follow-up, sharing some common manifestations of the syndrome, but also showing unique features. The principal features of this rare syndrome are further discussed.
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Affiliation(s)
- Spiros Miyakis
- Third Department of Internal Medicine, University of Athens, Athens, Greece
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Kelleher P, Misbah SA. What is Good's syndrome? Immunological abnormalities in patients with thymoma. J Clin Pathol 2003; 56:12-6. [PMID: 12499426 PMCID: PMC1769851 DOI: 10.1136/jcp.56.1.12] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Kelleher
- Department of Immunology, St Mary's Hospital, Praed Street, London W2 1NY, UK.
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Neumonía por citomegalovirus en paciente con inmunodeficiencia asociada a timoma. Rev Clin Esp 2003. [DOI: 10.1016/s0014-2565(03)71196-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Swaak AJ, van den Brink HG. Common variable immunodeficiency in a patient with systemic lupus erythematosus. Lupus 1996; 5:242-6. [PMID: 8803898 DOI: 10.1177/096120339600500314] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This report describes a young girl who developed systemic lupus erythematosus at the age of 11. In the years thereafter a conversion took place from hypergammaglobulinemia to hypogammaglobulinemia with the absence of circulating and bone marrow B-cells. Some aspects of the aetiopathogenesis of common variable immunodeficiency are discussed.
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Affiliation(s)
- A J Swaak
- Department of Rheumatology, Dr. Daniel den Hoed Clinic, Rotterdam, The Netherlands
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