Challenges in the Diagnosis of Good’s Syndrome a Case Report and Literature Review

Background Thymomas can disrupt normal thymopoiesis through reduced expression of the auto-immune regulator (AIRE) gene. This dysregulation may lead to immunodeficiencies, including Good’s syndrome, a rare paraneoplastic condition characterized by hypo-gammaglobulinemia, lymphopenia, diminished T cell mitogenesis, absence of circula-ting B cells, and susceptibility to opportunistic infections. Case Presentation: We report the case of a 54-year-old Colombian woman with a previously uncharacterized anterior mediastinal mass who presented with chronic diarrhea, severe neutropenia, and mucocutaneous herpes simplex infection. Immunological evaluation revealed hypogammaglobulinemia and absence of circulating B cells. After temporary immunomodulatory therapy and intravenous immunoglobulin replacement, the patient underwent surgical resection of the mediastinal mass, which was histologically confirmed as type A thymoma, establishing the diagnosis of Good’s syndrome. Conclusion Although Good’s syndrome has a variable clinical presentation, it should be recognized as a potential paraneoplastic manifestation of thymoma. Early diagnosis and targeted immunomodulatory treatment are critical for improving patient outcomes.