title: Successful treatment of Good syndrome with cytomegalovirus duodenoenteritis using a combination of ganciclovir and immunoglobulin with high anti-cytomegalovirus antibody titer.
abstract: We describe the case of a 64-year-old woman with Good syndrome who presented with watery diarrhea and abdominal distention caused by cytomegalovirus (CMV) duodenoenteritis. Thymoma and hypogammaglobulinemia were first identified when the patient was 58 years old. She had repeatedly complained of symptoms even after thymectomy. Abdominal radiography revealed multiple air-fluid levels, and computed tomography revealed ascites and dilation of the small intestine. Immunofluorescent staining of specimens obtained by duodenal mucosal biopsy revealed intracellular inclusion bodies of CMV, although serum CMV pp65 antigenemia assays yielded negative results. CMV infection of the small intestine caused mucosal edema resulting in malabsorption. The patient was treated using ganciclovir and an immunoglobulin preparation with a high titer of antibodies against CMV (CMV-Ig), and subsequently made a rapid recovery from abdominal symptoms. When patients with Good syndrome complain of abdominal symptoms, particularly chronic diarrhea, a diagnosis of CMV gastroenteritis should not be excluded, even if negative results are obtained for CMV pp65 antigenemia assays. Combination therapy of ganciclovir and CMV-Ig seems useful for patients with CMV gastroenteritis.
authors.affiliation: First Department of Internal Medicine, Kagoshima University, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Koriyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Fukumoto
authors.forename: Michiyo
authors.initials: M
authors.lastname: Fukudome
authors.forename: Katsumi
authors.initials: K
authors.lastname: Aso
authors.forename: Takafumi
authors.initials: T
authors.lastname: Hagiwara
authors.forename: Kosei
authors.initials: K
authors.lastname: Arimura
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nakazaki
authors.forename: Naomichi
authors.initials: N
authors.lastname: Arima
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Eizuru
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004382:Duodenitis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D005759:Gastroenteritis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008875:Middle Aged; D013934:Thymectomy; D013945:Thymoma / Q000150:complications* / Q000601:surgery; D013953:Thymus Neoplasms / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D015774:Ganciclovir