[CIS-PAGID] Good's syndrome

[Nelson, Robert P Jr]

Terri,
In the absence of clinical sequelae or chemotherapy-induced neutropenia, we have not used antimicrobial prophylaxis routinely but I worry a lot.  In the event of thrush, we have started fluconazole for treatment and then maintained prophylaxis.  We have had one patient with CMV retinitis and Good's that responded to ganciclovir, which we then used indefinitely until he died of other causes.  If the patient has had clinical herpes/zoster, we would use acyclovir or derivative indefinitely in prophylaxis dosages.   If the absolute CD4 count is less than 500/cumm, we use PCP prophylaxis when they are receiving chemo for the thymoma (translated from a suggestion in a chapter in Ochs, Smith, Puck (PID) about DiGeorge by Driscoll/Sullivan).  We would use neutropenic gram-neg prophylaxis for Good's when neutropenic after chemo.   We would use PCP prophylaxis for Good's in a patient who need steroids.

Interesting question, we need data regarding incidence of opportunistic infections in patients with Good's receiving IVIG unless I've missed something recent in the lit.
Bob

Robert P. Nelson Jr., MD
Professor of Medicine and Pediatrics
Divisions of Hematology/Oncology
535 Barnhill Dr. Ste 473
Indianapolis, IN  46202
Telephone: 317-948-1186
E-mail: ronelson at iupui.edu<mailto:ronelson at iupui.edu>
pager:  317-312-1773

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Terri Tarrant
Sent: Thursday, March 08, 2012 6:59 AM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Good's syndrome

I have a patient with newly diagnosed Good's syndrome with resected thymoma, severe hypogammaglobulinemia, absent CD19+ B cells, and recurrent sinopulmonary infections over the last 5-7 years.  There has been no documentation of severe viral, fungal, or opportunistic infections, and I have just started the patient on IgG replacement.  I wanted to query the group if you use prophylaxis in these patients, and if so, with what.

Many thanks for your thoughts,
Terri

--
Terri Tarrant, MD
Assistant Professor of Medicine
Thurston Arthritis Research Center
Lineberger Cancer Center Member
CB # 7280, 3300 Manning Dr.
Chapel Hill, NC 27599
(919) 843-4727
http://tarc.med.unc.edu/tarrant_welcome.php

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