Allergy, Asthma & Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
권호 표지
DOI QR코드

DOI QR Code

Cerebral toxoplasmosis in a patient with Good's syndrome: A case report and literature review

  • Seoyoung Choi (Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Mi Jung Kwon (Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Eun Soo Kim (Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Heui Seung Lee (Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Younghee Jung (Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Joo-Hee Kim (Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Seung Hun Jang (Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
  • Received : 2023.10.16
  • Accepted : 2024.01.04
  • Published : 2024.07.30
Download PDF
⟨ Previous Next ⟩

Abstract

Good's syndrome is a rare cause of combined B- and T-cell immunodeficiency in adults with a history of thymectomy. The patients with Good's syndrome are susceptible to encapsulated bacterial infections and opportunistic viral/fungal infections. We report a 63-year-old female patient who was diagnosed with cerebral toxoplasmosis in the middle of monthly immunoglobulin treatment for Good's syndrome. She was referred owing to progressive dizziness for one week without any neurologic deficits. Although routine laboratory tests and toxoplasma serology exams were within the normal range, brain image studies suggested cerebral toxoplasmosis, which was confirmed by pathology of brain lesions. She was treated with pyrimethamine and sulfadiazine as well as with systemic corticosteroids, and improved without sequelae. Later, her medication was switched to trimethoprim/sulfamethoxazole as a second-line treatment due to sulfadiazine-related neuropathy.

Keywords

Acknowledgement

This work was supported by a research grant (NRF-2021-R1I1A3050318) from the National Research Foundation (NRF) of Korea.

References

  1. 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.
  2. Kelleher P, Misbah SA. What is Good's syndrome? Immunological abnormalities in patients with thymoma. J Clin Pathol 2003;56:12-6.
  3. Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2009;58(RR-4):1-207;quiz CE1-4.
  4. RA G. Agammaglobulinaemia- a provacative experiment of nature. Bull Univ Minn Hosp Med Found 1945;26:1-19.
  5. Kabir A, Alizadehfar R, Tsoukas CM. Good's syndrome: time to move on from reviewing the past. Front Immunol 2022;12:815710.
  6. Tarr PE, Sneller MC, Mechanic LJ, Economides A, Eger CM, Strober W, et al. Infections in patients with immunodeficiency with thymoma (Good syndrome). Report of 5 cases and review of the literature. Medicine (Baltimore) 2001;80:123-33.
  7. Kim GW, Park JH, Nam EJ, Kim SW, Kang YM, Lee JM, et al. A case of Good's syndrome. J Asthma Allergy Clin Immunol 2002;22:142-7.
  8. Ryoo JY. Good's syndrome (thymoma with immunodeficiency): a case report. Korean J Thorac Cardiovasc Surg 2006;39:85-8.
  9. Kim JY, Chin JY, Lee SS, Jung H, Lee HK, Lee HP, et al. A case of Good syndrome: immunodeficiency syndrome associated with a thymoma. Korean J Med 2008;75:935-41.
  10. Song KH, Kim KH, Kim CJ, Park KU, Jheon S, Kim HB, et al. A case of Good's syndrome. Infect Chemother 2007;39:259-62.
  11. Lee SH, Lee SM, Yang SC, Yoo CG, Kim YW, Shim YS, et al. A case of granulomatous lung disease in a patient with Good's syndrome. Korean J Intern Med 2008;23:219-22.
  12. Kim HI, Chang HH, Park GY, Kwon EG, Kim HH, Kim SW, et al. Two cases of cytomegalovirus retinitis as a manifestation of Good's syndrome. Korean J Med 2011;81:266-72.
  13. Chung S, Lee K, Kim MJ, Chang HE, Song SH, Kim HB, et al. A case of Good's syndrome with weak ABO reverse type. Korean J Blood Transfus 2011;22:54-8.
  14. Jung H, Sohn KM, Kim YS, Song CH, Sohn EH. A case of thymoma with immunodeficiency (Good's syndrome) with disseminated tuberculosis. Korean J Med 2013;85:329-33.
  15. Kim SY, Kim JH, Hwang HW, Kim KY, Park S, Hwang YI, et al. Opportunistic lung infections as a manifestation of Good's syndrome. Allergy Asthma Respir Dis 2015;3:365-9.
  16. Kwon N, Kim HS. Tuberculosis Meningoencephalomyelitis in Good's Syndrome: a case report. Brain Neurorehabil 2020;13:e16.
  17. Ryu GH, Moon JW, Shin JM, Park IH. Good's syndrome presenting with chronic rhinosinusitis (1 case report). Korean J Otorhinolaryngol-Head Neck Surg 2022;65:169-73.
  18. 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;130:1604-9.
  19. Shi Y, Wang C. When the Good syndrome goes bad: a systematic literature review. Front Immunol 2021;12:679556.
  20. Ahn S, Cunningham-Rundles C. Role of B cells in common variable immune deficiency. Expert Rev Clin Immunol 2009;5:557-64.