Endoscopic sinus surgery for chronic rhinosinusitis associated with Good's syndrome: A case report

Abstract

Good's syndrome (GS) is associated with hypogammaglobulinemia and thymomas. It causes recurrent respiratory tract infections, including chronic rhinosinusitis (CRS). Many reports have stated that hypogammaglobulinemia is not improved by thymectomy, and intravenous gamma globulin (IVIG) is the most effective treatment for infection control. CRS occurs in approximately 9% of GS cases. Some studies have reported that chronic administration of macrolides is effective in treating sinusitis with GS. The treatment of CRS in cases of macrolide invalidity involves endoscopic sinus surgery (ESS); however, the specific effects of this surgery are not clearly understood. Herein, we report the case of a 56-year-old male patient with GS who underwent thymectomy for type AB thymoma and received regular IVIG treatment at our hospital. Long-term macrolides were administered for treating CRS, but postnasal drip and chronic cough remained severe. Pansinusitis, primarily involving the maxillary sinus, was revealed through computed tomography (CT). We performed ESS on both sides of the sinus under general anesthesia. Symptoms of nasal discharge, postnasal drip and chronic cough decreased by 85% after about 3 months of surgery, and inflammation in the lungs improved. ESS may be effective for treating CRS with GS when conservative medical treatment is ineffective.