COMBINED VARIABLE IMMUNODEFICIENCY AND MULTISYSTEM DYSFUNCTION IN A 53 YEAR-OLD FEMALE: A CASE REPORT

ABSTRACT

Introduction: Common Variable Immunodeficiency (CVID) is a heterogenous disease causing insufficient activity of the humoral arm of adaptive immunity. It is characterized by a broad paucity of serum immunoglobulins. Patients are not only predisposed to recurrent infections, they also are more likely to develop certain cancers and autoimmune diseases. Case Description We present a case of a 53 year-old female suffering from recurrent pulmonary infections and a past history of Non-Hodgkin’s Lymphoma who came for evaluation of drug allergies. By eliciting a thorough history, it was found that she had a poor response to the MMR and Varicella vaccines as a child, and was infected with COVID-19 twice in 2020. Additionally, longitudinal chest CT scans demonstrated bilateral pulmonary nodules, indicative of chronic inflammation. Testing of her antibody titers in order to determine suitability for S. Pneumoniae vaccination found an overall decrease in major immunoglobulin classes (IgG, IgM, and IgA). Hematological testing showed B-cells with normal morphology. The diagnosis of CVID was made, and prompt treatment with IVIG (intravenous immunoglobulins) was initiated, bringing her IgG levels from 282 to 680 (mg/dL) within three months. Discussion: Her constellation of symptoms and diseases likely arose as a result of immune dysfunction, highlighting the necessity of keeping immunodeficiencies like CVID on the differential when managing patients with seemingly unrelated medical problems. Early detection of immunopathologies like CVID should therefore be a priority for longitudinal care. This ideally ensures early detection and prompt management of the multi-system dysfunctions that pose a significant lifetime risk to such patients.