title: Atypical VZV Retinitis in a Patient with Good Syndrome.
abstract: OBJECTIVE
  To describe atypical varicella zoster virus (VZV) retinitis in a patient with Good syndrome.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: a Department of Ophthalmology , Juntendo University School of Medicine , Tokyo , Japan.
authors: Takenori
authors: http://orcid.org/0000-0003-3435-1055
authors: T
authors: Inomata
authors: b Department of Ophthalmology , Juntendo University Urayasu Hospital , Chiba , Japan.
authors: Miki
authors: M
authors: Honda
authors: a Department of Ophthalmology , Juntendo University School of Medicine , Tokyo , Japan.
authors: Akira
authors: A
authors: Murakami
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000361:Agammaglobulinemia / Q000150:complications*; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000032:analysis; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D005451:Fluorescein Angiography; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012173:Retinitis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D013945:Thymoma / Q000150:complications*; D013953:Thymus Neoplasms / Q000150:complications*; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir
keywords: Good syndrome; VZV retinitis; progressive outer retinal necrosis; thymoma