Atypical VZV Retinitis in a Patient with Good Syndrome

Ocul Immunol Inflamm. 2018;26(2):194-198. doi: 10.1080/09273948.2016.1201518. Epub 2016 Aug 5.


Purpose: 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.

Conclusion: 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.

Keywords: Good syndrome; VZV retinitis; progressive outer retinal necrosis; thymoma.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / analogs & derivatives
  • Acyclovir / therapeutic use
  • Agammaglobulinemia / complications*
  • Antiviral Agents / therapeutic use
  • Aqueous Humor / virology
  • CD4 Lymphocyte Count
  • DNA, Viral / analysis
  • Eye Infections, Viral / diagnosis
  • Eye Infections, Viral / drug therapy
  • Eye Infections, Viral / virology*
  • Fluorescein Angiography
  • Herpes Zoster Ophthalmicus / diagnosis
  • Herpes Zoster Ophthalmicus / drug therapy
  • Herpes Zoster Ophthalmicus / virology*
  • Herpesvirus 3, Human / isolation & purification*
  • Humans
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Retinitis / diagnosis
  • Retinitis / drug therapy
  • Retinitis / virology*
  • Thymoma / complications*
  • Thymus Neoplasms / complications*
  • Valacyclovir
  • Valine / analogs & derivatives
  • Valine / therapeutic use
  • Visual Acuity / physiology


  • Antiviral Agents
  • DNA, Viral
  • Valine
  • Valacyclovir
  • Acyclovir