# A Case of Oral Lichen Planus Preceding the Diagnosis of Good Syndrome

## TL;DR

A patient with oral lichen planus was later diagnosed with Good syndrome, highlighting a rare but important clinical association.

## Contribution

This case report highlights the rare association between refractory oral lichen planus and Good syndrome, emphasizing the need for vigilance in diagnosis.

## Key findings

- A patient with oral lichen planus was later diagnosed with Good syndrome and common variable immunodeficiency.
- The patient's oral symptoms were managed with topical corticosteroids and antifungal therapy.
- The case underscores the increased risk of oral squamous cell carcinoma in patients with Good syndrome and active OLP.

## Abstract

Good syndrome (GS) is a rare condition characterized by thymoma and immune deficiency with a poorly understood mechanism in which patients have reduced immunoglobulin levels and circulating B-cells along with impaired T-cell function. GS is often accompanied by autoimmune and inflammatory conditions, and in this report, we present a case of refractory oral lichen planus (OLP) preceding the diagnosis of GS. In this case, a patient with a history of OLP was diagnosed with GS and common variable immunodeficiency (CVID) following thymectomy and was treated with intravenous immunoglobin (IVIG). Additionally, he was found to have pure red cell aplasia managed with cyclosporine. His oral symptoms worsened, and he presented to dermatology. Treatment was initiated with topical clobetasol and tacrolimus for his OLP, and fluconazole was started for concomitant oral candidiasis. His OLP has remained under satisfactory control with this regimen; however, he requires close surveillance for malignancy given his increased risk of oral squamous cell carcinoma (OSCC) with immunosuppression and active OLP. Although rare, clinicians should be aware of GS and its association with erosive OLP along with the heightened risk of infection in these patients.