Patient: Male, 55-year-old Final Diagnosis: CMV infection • Good syndrome • thymoma Symptoms: Recurrent infection preceded by thymoma Medication:— Clinical Procedure: — Specialty: Hematology • Immunology • Oncology • Ophthalmology • Surgery Objective: Rare disease Background: Good syndrome (thymoma with immunodeficiency) is a frequently missed and forgotten entity. It is a rare cause of combined B and T cell immunodeficiency in adults. To date, fewer than 200 patients with Good syndrome have been reported in the literature. Case Report: We report a case of type AB Masaoka-Koga stage I thymoma which predated the evidence of immune dysregulation by 5 years, manifesting as bilateral cytomegalovirus retinitis, multiple bouts of pneumonia, and bronchi-ectasis in a HIV-seronegative 55-year-old man. Intravitreal ganciclovir was administered in addition to intravenous systemic ganciclovir, which resulted in severe neutropenic sepsis. A thorough immunodeficiency workup confirmed the presence of hypogammaglobulinemia with complete absence of B cells and reduced CD4/CD8 ratio. The patient responded well to monthly intravenous immunoglobulin replacement therapy, with no further episodes of infection since then. The immunoglobulin level doubled after 1 year of treatment. However, as the patient refused further intravitreal and CMV-targeted treatment, his vision did not recover. Conclusions: Clinicians should be aware that thymoma can precede the onset of immunodeficiency. Clinical suspicion should be heightened in at-risk patients who present with multiple bouts of infection, particularly in thymoma cases with adult-onset immune dysfunction. It is of paramount importance to follow up those patients with annual clinical reviews and immunodeficiency screening.

This case report aims to discuss a case of tobacco-alcohol optic neuropathy secondary to alcohol abuse and chronic cigarette smoking in a 43-year-old man. Possible causes including vitamin B12 deficiency, methanol poisoning, and cyanide in tobacco were discussed. Clinical examination and blood investigation supported the diagnosis of vitamin B12 deficiency, possibly precipitated by methanol and cyanide. The patient was treated with vitamin B12 and folinic acid and asked to abstain from smoking and alcohol consumption. His left eye vision had improved to premorbid vision but there no improvement on the right eye. As a conclusion, tobacco-alcohol optic neuropathy is a diagnosis of exclusion and treatment shows variable response.

We reported a rare case of neuroretinitis secondary to cat scratch disease, which was successfully treated with steroids and antibiotic. A healthy young lady presented with a 6-day history of central blurring of vision over her right eye (OD) after an episode of flu. Visual acuity over the OD was 6/60 with positive relative afferent pupillary defect. There were no features of anterior uveitis. Fundus of the OD showed swollen, hyperemic optic disc with disc hemorrhages and early macular star but clear vitreous, with the absence of retinochoroiditis or vasculitic changes. The serum Bartonella henselae immunoglobulins M and G were raised. Magnetic resonance imaging of the brain and orbit showed a normal result. Our impression was neuroretinitis secondary to cat scratch disease. Her OD’s vision improved to 6/9 after completing a course of doxycycline and systemic corticosteroids. Early commencement of antibiotic and corticosteroids is essential to impede potentially blinding ocular complications despite its rarity.