Paciente con síndrome de Good y COVID-19. Reporte de un caso clínico

BACKGROUND: The consequences of SARS-CoV-2 infection in patients with primary (now called "inborn errors of immunity") or secondary immunodeficiencies is still a matter of debate. There are few reports in the literature of patients with Good’s syndrome and SARS-CoV-2 infection with variable outcomes. CLINICAL CASE: A 51-year-old male with diagnosis of Good's syndrome treated with intravenous human immunoglobulin (IVIG) at a replacement dose with application every 21 days and prophylaxis for P. jirovecii with trimethoprim/sulfamethoxazole due to profound lymphopenia at expense of T CD4+ lymphocytes who presented initially mild disease (RT-PCR+) that progressed to pneumonia with acute respiratory failure and required advanced airway management and admission to the ICU with a fatal outcome due to superinfection after 14 days hospitalized. CONCLUSION: It has been documented in patients with humoral immunodeficiencies a better prognosis for developing less intense cytokine release syndrome. The alteration in cellular immunity, especially lymphopenia at the expense of CD4+ T lymphocytes, may be associated with a worse prognosis as the response against viruses is compromised as well as high susceptibility to superinfection by opportunistic agents such as P. aeruginosa and Mucor sp. For this reason, we must maintain close surveillance in patients with inborn errors of immunity with cellular defects, as is the case of patients with Good’s syndrome who present with COVID-19.