Tuberculosis Meningoencephalomyelitis in Good's Syndrome: a Case Report

• Published in: Brain & NeuroRehabilitation Vol. 13; no. 3; pp. e16 - 6
• Main Authors: Kwon, Namwoo, Kim, Hyoung Seop
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society for Neurorehabilitation 01.11.2020; 대한뇌신경재활학회
• Subjects: Case Report; 재활의학; Immunologic Deficiency Syndromes; Rehabilitation; Thymoma; Myasthenia Gravis; Tuberculosis Meningitis
• ISSN: 1976-8753; 2383-9910; 2383-9910
• DOI: 10.12786/bn.2020.13.e16

Good's syndrome is a rare disease characterized by thymoma associated with combined B- and T-cell immunodeficiency in adults. Due to the lack of early onset of symptoms, it is difficult to diagnose this disorder. A 44-year-old man diagnosed with thymic carcinoma was admitted to the hospital with quadriplegia for 6 months. Brain abscess and meningoencephalitis were identified in the magnetic resonance imaging (MRI) of the brain. Antibiotics, steroid, and intravenous immunoglobulin treatment were provided for 3 months. Follow-up MRI showed progression to C7-level. The radiologic findings were consistent with tuberculosis infection and thus, the patient was treated with anti-tuberculosis medication. MRI of the brain and spine showed an improved state of meningoencephalomyelitis. In a laboratory study, there were decreased levels of peripheral B-cell and CD4 T-cell and decreased CD4:CD8 ratio; therefore, it confirmed that cellular immunity deteriorated. In addition to clinical findings, we were able to diagnose the patient with Good's syndrome. Good's syndrome is a highly suspicious disease in patients with thymoma who have recurrent unusual infections. Immunologic tests should be performed for diagnosis in which it can prevent delayed diagnosis and allow timely treatment.