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CASE REPORT article

Front. Med.

Sec. Pulmonary Medicine

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1649584

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

Provisionally accepted
Wenjing  ZENGWenjing ZENG1xiaoyi  fengxiaoyi feng2binmiao  liangbinmiao liang3xuemei  ouxuemei ou3*
  • 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

The final, formatted version of the article will be published soon.

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.

Keywords: Good syndrome, Thymoma, pulmonary infection, Common Variable Immunodeficiency, Intravenous Immunoglobulin

Received: 18 Jun 2025; Accepted: 04 Aug 2025.

Copyright: © 2025 ZENG, feng, liang and ou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: xuemei ou, Sichuan University West China Hospital Department of Respiratory and Critical Care Medicine, Chengdu, China

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