Good’s syndrome is a rare condition defined as thymoma with immunodeficiency. It manifests as a combined B and T cell immunodeficiency in middle aged adults with increased susceptibility to bacterial infections with encapsulated organism & opportunistic viral and fungal infections. The most consistent immunological abnormalities are hypogammaglobulinemia and reduced or absent B cells.
The association of Good’s syndrome with oral erosive Lichen Planus has been documented with 27 cases reported in the medical literature.
We report a case of a 51 year old Caucasian female who presented to Canberra hospital with 4 months history of extensive painful mouth ulcerations and significant weight loss who was subsequently found to have Good’s syndrome and biopsy proven oral lichen planus. She subsequently underwent thymectomy and started IVIG infusions which resulted in improvement of her blood counts and correction of her immunodeficiency. Unfortunately, her oral lichen planus remains resistant to various treatments including dexamethasone mouth washes, Tacrolimus 0.1% ointment, and oral prednisolone.
This case highlights the issue of investigating patients with resistant oral Lichen Planus to rule out Good’s syndrome and the implications for treatment and follow up.