Common variable immunodeficiency diagnosed during the treatment of bronchial asthma: Unusual cause of wheezing

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• 作者：Tomohiro Akaba^a ; Mitsuko Kondo^a ; Midori Toriyama^a ; Ayako Kubo^a ; Kaori Hara^a ; Takeshi Yamada^a ; Kentaro Yoshinaga^b ; Jun Tamaoki^a ; ^{jtamaoki@chi.twmu.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Primary immunodeficiency ; Common variable immunodeficiency ; Bronchial asthma ; Wheezes ; Airway infection ; Hypogammaglobulinemia
• 刊名：Respiratory Medicine Case Reports
• 出版年：2015
• 出版时间：2015
• 年：2015
• 卷：16
• 期：Complete
• 页码：41-44
• 全文大小：495 K

文摘

Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency in adults and children. We herein report a case of CVID, who was misdiagnosed with asthma due to wheezing episodes and relatively late onset. A 51-year-old woman had suffered from recurrent upper and lower airway infection for recent 2 years. She repeated wheezing attacks and was treated as asthma exacerbation triggered by infection. She was referred to our hospital for investigation and treatment. Lung function tests showed no reversibility of FEV₁ by β-adrenergic agonist, but the increase of V₅₀/V₂₅. Chest CT showed slight to moderate bronchial wall thickening and bronchiectasis. After that, she suffered from pneumonia with wheezing attacks twice a month, and immunodeficiency was strongly suspected. Her blood tests showed marked decreases of all classes of immunoglobulin and nearly lack of memory B cells, NKT cells and plasmacytoid dendritic cells. She was diagnosed with CVID, and was treated with replacement of gammaglobulin. Thereafter, her wheezing episodes with infection were remarkably improved. Because the delay of diagnosis with CVID likely causes poor mortality and morbidity, a possibility of CVID should be considered in patients with frequent asthma-like symptoms due to recurrent airway infection.