a Department of Ophthalmology , Juntendo University School of Medicine , Tokyo , Japan.
b Department of Ophthalmology , Juntendo University Urayasu Hospital , Chiba , Japan.
Ocul Immunol Inflamm. 2018;26(2):194-198. doi: 10.1080/09273948.2016.1201518. Epub 2016 Aug 5.
To describe atypical varicella zoster virus (VZV) retinitis in a patient with Good syndrome.
A 63-year-old patient with Good syndrome presented with bilateral necrotizing retinitis starting from the posterior pole. He had a history of thymoma status post thymectomy 4 years previously, left-sided sinusitis, and recent pulmonary aspergillosis. Qualitative PCR was performed on aqueous fluid.
Immunological investigations revealed reduced levels of CD4 T cells and immunoglobulins. Qualitative PCR was positive for VZV and negative for cytomegalovirus, herpes simplex virus (HSV)-1, and HSV-2. The patient was treated with oral valacyclovir and three courses of immunoglobulin supplementation. The atypical retinitis showed improvement after therapy.
Good syndrome should be considered in a patient with opportunistic infections and history of thymoma in the absence of human immunodeficiency virus. Atypical retinitis can occur in patients with Good syndrome and quantitative PCR is important for accurate diagnosis.
描述 Good 综合征患者出现不典型带状疱疹病毒（VZV）视网膜炎。
一位 63 岁的 Good 综合征患者出现双侧从后极开始的坏死性视网膜炎。他在 4 年前因胸腺瘤行胸腺切除术，有左侧鼻窦炎和近期肺曲霉病病史。对房水进行了定性 PCR 检测。
免疫学检查显示 CD4 T 细胞和免疫球蛋白水平降低。定性 PCR 对 VZV 呈阳性，对巨细胞病毒、单纯疱疹病毒 1 型（HSV-1）和单纯疱疹病毒 2 型（HSV-2）呈阴性。该患者接受了口服伐昔洛韦和 3 个疗程的免疫球蛋白补充治疗。治疗后，不典型视网膜炎有所改善。
在没有人类免疫缺陷病毒的情况下，对于伴有机会性感染和胸腺瘤病史的患者，应考虑 Good 综合征。Good 综合征患者可出现不典型视网膜炎，定量 PCR 对准确诊断很重要。
