It Took a Village: Good's Syndrome

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PRESENTATION A complex medical history became even more tangled when a 52-year-old man presented with a 4-week history of dry cough, dyspnea, weight loss, chills, subcutaneous nodules on his extremities, and fatigue. He had no fever. Initially, his primary care physician examined him and prescribed a course of clindamycin. Although the patient completed therapy, the nodules continued to progress, and they began to drain purulent material. He had been diagnosed with myasthenia gravis 7 years prior to this episode, and he was maintained on prednisone 20 mg daily and pyridostigmine. An associated thymoma had metastasized to his lung, and he had been treated with chemotherapy and radiation 2 years before this presentation. The course of his illness was further complicated by thymoma-associated pure red cell aplasia, which was successfully managed with cyclosporine.