Abstract
Good's syndrome (GS) is a primary immunodeficiency characterized by thymoma-associated hypogammaglobulinemia, leading to recurrent infections. A 71-year-old woman, with a history of oral and perineal lichen planus, chronic sinusitis, recurrent otitis, and thymoma excision in 2021, presented with fever and diarrhea after testing positive for SARS-CoV-2. On admission, she appeared stable but had bleeding lichen planus lesions and required supplemental oxygen for moderate respiratory insufficiency. Laboratory results revealed leukocytosis with neutrophil predominance and mild inflammation. A diagnosis of GS was made based on the history of thymoma, detection of hypogammaglobulinemia, and an imbalance in cellular immunity. Additionally, blood cultures grew Campylobacter coli, and she completed a 14-day regimen of azithromycin. After completing the antibiotic course, her respiratory condition worsened with progressive bilateral infiltrates seen on X-ray. The polymerase chain reaction-multiplex respiratory pathogen panel was positive only for SARS-CoV-2. Despite mechanical ventilation, treatment with broad-spectrum antibiotic therapy, and immunoglobulin replacement, her condition continued to deteriorate. The patient's clinical deterioration was attributed to the combined immunodeficiency from GS and the co-infection of SARS-CoV-2 and C. coli bacteremia. At this point, SARS-CoV-2 remained detectable through the multiplex respiratory panel, and inflammatory markers were elevated, with a C-reactive protein of 21.13 mg/dL, procalcitonin of 0.69 ng/mL, and leukocytosis of 11.7 × 10⁹/L with neutrophilia (10.51 × 10⁹/L). This case emphasizes the risk of severe infections in patients with GS, as well as the importance of early detection and comprehensive management of concurrent bacterial and viral infections in immunocompromised individuals.