Good Syndrome With Thymoma and Bronchiectasis in a 71-year-old Patient

Abstract

Abstract Introduction: Good syndrome is a rare entity accounts for only 5% of parathymic syndromes and is characterized by the association of a thymoma, hypogammaglobulinemia, and recurrent infections, primarily bronchopulmonary, which can sometimes lead to bronchiectasis. Case report: A 71-year-old male patient, father of four, with a history of chronic smoking (30 pack-years, quit 20 years ago) and chronic bronchitis, as well as a history of treated pulmonary tuberculosis in 1980. His current symptoms began 4 years ago with recurrent bronchopulmonary infections, worsening over the past year with exacerbation of his chronic cough, increased mucopurulent sputum production, and episodes of minor, recurrent hemoptysis that resolved spontaneously. Pulmonary examination revealed a BMI of 23 kg/m², diffuse rhonchi, and bilateral basal crackles and rhonchi. The remainder of the physical exam, including cardiovascular, lymphatic, and abdominal assessments, was unremarkable. Among the tests performed, a complete blood count showed hemoglobin at 14 g/dl, white blood cell at 9930, with lymphocytes at 1972, and C-reactive protein (CRP) at 16 mg/l. HIV, hepatitis B, and C serologies were negative. Three sputum samples for acid-fast bacilli (AFB) and cultures were negative. Protein electrophoresis revealed hypogammaglobulinemia at 5 g/l. A thoracic CT scan revealed an anterior mediastinal mass, lateralized to the right, measuring 79 mm in its largest dimension. The mass was oval-shaped, well-defined, and of heterogeneous density, abutting the pericardium without signs of invasion. There were also a few mediastinal lymph nodes, with the largest measuring 12 mm in the pretracheal region. Additionally, bilateral moniliform and cystic bronchiectasis were noted, along with cystic fibrosis affecting the entire lower right lobe. A CT-guided biopsy of the mediastinal mass confirmed a type A thymoma. Bronchoscopic examination revealed abundant diffuse bronchorrhea without visible obstruction of the bronchial tree. The GeneXpert test, as well as bacteriological and parasitological analyses of the bronchial aspirate, were negative. The association of a thymoma with hypogammaglobulinemia, recurrent bronchopulmonary infections, and CT findings of diffuse cylindrical and cystic bronchiectasis led to the diagnosis of Good syndrome in our patient. However, the patient declined surgical resection and has since been lost to follow-up. DISCUSSION: Although rare, Good syndrome can be an underlying cause of bronchiectasis. Serum protein electrophoresis is a simple test that should be performed in patients with recurrent lower respiratory tract infections and/or bronchiectasis, particularly when a thymoma is present.