The reported predisposing risk factors for CMV retinitis are older age, leukemia, systemic autoimmune disease, organ transplantation, lymphoma, diabetes mellitus, Good syndrome, immunosuppressive therapy, and multiple myeloma .
Cunningham, "Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients--case report and comprehensive review of the literature," Journal of Ophthalmic Inflammation and Infection, vol.
Good syndrome is a rare disease that comprises thymoma and humoral immunodeficiency.
Durtschi et al., "TACI mutation p.Lys154Ter identified in good syndrome," Clinical Immunology, vol.
Good syndrome (thymoma with immunodeficiency) is a rare cause of immunodeficiency.1 There is a combined B and T cell immunodeficiency with hypogammaglobulinemia, reversal of the CD4/CD8 ratio and reduced or absent B cells causing an increased susceptibility to bacterial, viral and fungal infections.
Based on these findings he was treated with intravenous immunoglobulin's for Good syndrome during his stay in ICU.
Patients with Good syndrome usually present in the 4th or 5th decade of life, and the frequency in males and females is similar.
Although systemic fungal infections are not characteristic of Good syndrome, mucocutaneous candidiasis has been documented in 24% of cases.4 Aspergillus is a rare cause complicating Good syndrome and a recent review of 152 Good syndrome cases revealed only 4 cases of aspergillus infections.1,9,11 In our case, given the overall critical condition of the patient, transbronchial lung biopsy could not be performed to confirm invasive aspergillosis.
Autoimmune diseases such as myasthenia gravis, pure red-cell aplasia, pernicious anaemia, diabetes mellitus, and idiopathic thrombocytopenia may also be concomitantly present in these patients.2 The treatment of patients with Good syndrome includes resection of the thymoma and immunoglobulin replacement to maintain adequate IgG levels.