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

Abstract

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.

Immunological and Biochemical Features in Bronchial Asthma in Children

“…[1,2,3] It is known that the lungs are the central organ of regulation of all parts of hemostasis, control and prevention of thrombogenesis. [4,5] In turn, the interaction and activation of blood coagulation factors occurs on the surface of circulating phospholipid membranes. [6,7,8] At the same time, the involvement of the hemostasis system in immune-inflammatory processes is beyond doubt, but the complex mechanisms of changes in hemocoagulation and their role in the progression of bronchial asthma in children require further study, since the literature data are very contradictory.…”