Good Syndrome Presenting with Multiple Pulmonary Infections: A Case Report Involving Metagenomic Sequencing Diagnosis

Wenjing ZENG¹xiaoyi feng²binmiao liang³xuemei ou^3*

• ¹Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
• ²Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
• ³Sichuan University West China Hospital Department of Respiratory and Critical Care Medicine, Chengdu, China

Good syndrome (GS), alternatively termed thymoma with immunodeficiency, is a rare adult-onset immunodeficiency disorder characterized by concurrent thymoma and hypogammaglobulinemia, accompanied by defects in both B-cell-mediated immunity and T-cell-mediated immunity. Owing to nonspecific clinical presentation, diagnosis is frequently delayed, resulting in poor prognosis and elevated mortality.In this study, we report a case of GS in a 69-year-old male patient who presented with symptoms of recurrent cough and productive sputum. Metagenomic next-generation sequencing (mNGS) of oropharyngeal swabs detected multiple microorganisms, including SARS-CoV-2 (35,047 reads), Epstein-Barr virus (7,236 reads), Micromonas pusilla (3,674 reads), Bacillus spp. (3,284 reads), cytomegalovirus (1,203 reads), and herpes simplex virus type 1 (575 reads). Following a comprehensive clinical evaluation-including recurrent pulmonary infections, history of thymoma and lymphopenia with immunodeficiency-the diagnosis of GS was confirmed. This patient received an intensified anti-infective regimen: broad-spectrum carbapenem meropenem as backbone therapy, combined with antifungal agents and antiviral treatment (IV ganciclovir and oral molnupiravir).After aggressive anti-infection therapy, the patient experienced clinical improvement and chest CT demonstrated significant radiographic improvement.Although intravenous immunoglobulin (IVIG) is foundational in GS, intensive antimicrobial therapy is also critical for clinical outcomes.