Invasive pulmonary aspergillosis as a sentinel manifestation of good syndrome in a patient with thymoma.

Background: Good syndrome is a rare adult-onset combined immunodeficiency associated with thymoma, characterized by hypogammaglobulinemia and impaired T-cell-mediated immunity. Opportunistic infections are a major cause of morbidity and mortality, and invasive aspergillosis may represent a severe but underrecognized manifestation. In some cases, it may serve as a sentinel presentation leading to the diagnosis of Good syndrome. Case presentation: A 52-year-old man presented with a history of thymoma and myasthenia gravis, chronic sinopulmonary infections, cytomegalovirus colitis, chronic diarrhea, and cytopenia. Chest CT scan revealed multiple pulmonary nodules and tree-in-bud opacities. Bronchoalveolar lavage, galactomannan assay, and lung biopsy confirmed Aspergillus infection. Subsequent comprehensive immunologic evaluation demonstrated hypogammaglobulinemia, markedly reduced peripheral B cells (CD19⁺), and impaired T-cell immunity, consistent with Good syndrome. Conclusion: Invasive pulmonary aspergillosis can serve as a key sentinel manifestation leading to the diagnosis of Good syndrome in patients with thymoma. Early recognition of opportunistic infections and prompt immunological assessment are critical for timely treatment and improved clinical outcomes.