# Good’s Syndrome With Pure Red Cell Aplasia and Subclinical Myasthenia Gravis: A Case Report and Review of Literature

## TL;DR

This paper reports a rare case of Good’s syndrome with pure red cell aplasia and subclinical myasthenia gravis, highlighting treatment responses and distinct mechanisms.

## Contribution

The novelty lies in documenting a rare case of Good’s syndrome with both PRCA and subclinical myasthenia gravis, and analyzing treatment outcomes.

## Key findings

- Cyclosporine A improved pure red cell aplasia but did not recover hypoglobulinemia.
- Anti-acetylcholine receptor antibody levels remained unchanged despite treatment.
- Distinct mechanisms may underlie PRCA and hypoglobulinemia in this syndrome.

## Abstract

Good's syndrome is a pathologic condition characterized by thymoma and immunoglobulin disorder. Here, we report a rare case of a patient with Good’s syndrome with simultaneous pure red cell aplasia (PRCA) and subclinical myasthenia gravis with detectable serum anti-acetylcholine receptor antibody (AChR Ab). While thymectomy did not result in the improvement of any paraneoplastic syndromes, cyclosporine A (CsA) treatment successfully improved PRCA; however, hypoglobulinemia was not recovered, and anti-AchR Ab did not disappear by CsA treatment in our case. A review of the literature on simultaneous Good’s syndrome with PRCA also suggested the efficacy of CsA on PRCA but not hypoglobulinemia, suggesting the distinct underlying mechanisms between these two paraneoplastic symptoms with thymoma. Future research is needed to understand the mechanism underlying this rare pathologic condition and to generate appropriate treatment.