ABSTRACT
Good's syndrome is a rare adult-onset combined immunodeficiency. The association of hypogammaglobulinaemia with a history of recurrent infectious or autoimmune manifestations in a middle-aged patient with evidence of a mediastinal mass should lead to the clinical suspicion of Good's syndrome. The mortality rate associated with infectious complications is high. Thus, although it is rare, the disease should be diagnosed early so that proper treatment can be started. Thymectomy and immunoglobulin replacement are the main therapeutic strategies. We describe the case of a patient with a history of thymoma and recurrent respiratory infections, with a late diagnosis of Good's syndrome in the context of severe organizing pneumonia secondary to COVID-19. LEARNING POINTS: Infection is the leading cause of mortality in patients with Good's syndrome.Early recognition of this rare disease and substitutive therapy with immunoglobulin may have an important impact on prognosis.Due to its rarity, data on Good's syndrome are scarce and its association with severe COVID-19 onset is still unclear.To the best of our knowledge, this is the fifth case report of COVID-19 in a patient with Good's syndrome, the third with a favourable outcome.
Subject(s)
Cyclooxygenase 2 Inhibitors/adverse effects , Dermatitis, Exfoliative/chemically induced , Etodolac/adverse effects , Aged , Anti-Infective Agents, Local/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Betamethasone/therapeutic use , Dermatitis, Exfoliative/drug therapy , Dermatitis, Exfoliative/pathology , Emollients , Female , Humans , Prednisolone/therapeutic useABSTRACT
BACKGROUND: Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications. OBJECTIVES: To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death. METHODS: We included 396 consecutive ischemic stroke patients submitted to recombinant tissue plasminogen activator treatment between January 2011 and September 2014. Admission CT-scans were reviewed to calculate the Total Carotid Syphon Calcification score. Patients were followed for up to at least 6 months post-stroke or until death. Outcome measures included evaluation of recanalization on the first 24 h (transcranial color coded Doppler or angio-CT), sICH, and assessment of functional outcome at 3 months after stroke (using modified Rankin scale). RESULTS: Carotid artery wall calcification did not predict sICH, recanalization or any good outcome. However, it was a statistically significant predictor of death (OR 1.102, 95% CI [1.004-1.211], p = 0.042). DISCUSSION: Intracranial carotid artery calcification does not increase the risk of thrombolysis-induced sICH. Patients with higher grade of carotid artery wall calcification may have a higher mortality rate.