An unusual mimicker of asthma in an active duty army physician: Common variable immunodeficiency presenting as granulomatous lymphocytic interstitial lung disease

We present a 48 year-old active duty physician who initially presented in 2007 with dyspnea and cough. Despite the absence of variable obstruction on spirometry, a clinical diagnosis of asthma was made. The patient's symptoms were temporized with inhaled corticosteroids and bronchodilators, titrated to his symptoms, until eventual therapeutic failure resulted in re-referral to pulmonary. Chest computed tomography (CT) showed ground-glass nodules and patchy airspace opacities with evidence of thoracic lymphadenopathy. A positron emission tomography CT (PET CT) showed diffuse adenopathy throughout his thorax and abdomen with high avidity for fluorodeoxyglucose (FGD)-18. This prompted a comprehensive pathologic and serologic evaluation that unveiled a diagnosis of granulomatous-lymphocytic interstitial lung disease (GLILD) secondary to common variable immunodeficiency (CVID). Once the diagnosis was made, the patient was treated with intravenous immunoglobulin resulting in clinical improvement. Given the patient's time-to-diagnosis and response to IVIG monotherapy, this case serves as a unique presentation of a rare pathophysiologic entity which should be considered in refractory cough and dyspnea with radiographic abnormalities.
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research

Related Links:

Authors: Yang L, Liu S, Fang W, Chen J, Chen Y Abstract The aim of the present study was to investigate the feasibility of using composite scaffolds of poly(lactic-co-glycolic acid) (PLGA) and bioactive glass (BG) to repair bone defects. PLGA/BG composite scaffolds were prepared by thermally-induced phase separation. Scanning electron microscopy (SEM) was used to study the morphology, and liquid (absolute ethanol) replacement was used to calculate the porosity of the scaffold. The biocompatibility and degradation of the scaffold were determined using human osteosarcoma cell line MG-63 and animal experiments. SEM sh...
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
Background: Current eligibility criteria for urine lateral-flow lipoarabinomannan assay (LF-LAM) in ambulatory, HIV-positive patients rely on the CD4 count. We investigated the diagnostic yield of LF-LAM and the 6-month mortality in ambulatory, TB symptomatic, HIV-positive patients regardless of their CD4 count. Methods: We conducted a prospective, observational study that included all ambulatory, ≥15-year-old, TB symptomatic (cough, weight loss, fever, or night sweats) HIV-positive patients presenting at 4 health facilities in Malawi. Patients received a clinical examination and were requested urine LF-LAM, sputum...
Source: JAIDS Journal of Acquired Immune Deficiency Syndromes - Category: Infectious Diseases Tags: Implementation Science Source Type: research
Publication date: Available online 5 December 2019Source: Materials Research BulletinAuthor(s): Jahaziel Amaya, Luis Bobadilla, Lola Azancot, Miguel Centeno, Sonia Moreno, Rafael MolinaAbstractEnhancement of the main physicochemical properties of a natural bentonite was carried out by means of modifications using surfactant, reflux, microwave treatment and, subsequently, the incorporation of AlZr and AlCe species. The evolution of the main changes in each modification stage was evaluated by means of X-ray diffraction, N2 sortometry, scanning microscopy (SEM), NH3-TPD, NH3-DRIFTS and CO adsorption at low temperature. For th...
Source: Materials Research Bulletin - Category: Materials Science Source Type: research
Publication date: Available online 5 December 2019Source: Materials LettersAuthor(s): Kiyoshi Matsuyama, Tomohiro Tsubaki, Takafumi Kato, Tetsuya Okuyama, Hiroyuki MutoAbstractGold nanoparticles (Au NPs) in liquid poly (ethylene glycol) (PEG) were prepared via sputter deposition. This is an easy and simple preparation method for Au NPs , and does not require a chemical reaction or additional stabilizers. A metal-organic framework (MOF), Cu3(BTC)2 (BTC: 1,3,5-benzenetricarboxylic acid), was synthesized in the liquid PEG containing the Au NPs to obtain Au@Cu3(BTC)2. Liquid PEG acted as the capture medium for sputter depositi...
Source: Materials Letters - Category: Materials Science Source Type: research
A 34-year-old undocumented woman from Mexico, past medical history of asthma and rheumatoid arthritis (RA) presents to the ED with fever, myalgia, fatigue, cough, and difficulty taking deep breaths for the past 3 days requiring albuterol inhaler three to four times a day. Her symptoms worsened 1 h prior to arrival.
Source: QJM - Category: Internal Medicine Source Type: research
Introduction: EuroQol Five Dimensions Five Level questionnaire (EQ-5D-5L) can be used to assess generic health status and cost-utility. We investigated EQ-5D-5L health status in chronic cough and performed a systematic review of the literature in other respiratory diseases.Method: Prospective study of patients with chronic cough from a specialist clinic who completed EQ-5D (range -0.594 to 1; high score = better health), cough severity visual analogue scale (VAS) and Leicester Cough Questionnaire (LCQ). Systematic review of literature was conducted for studies of EQ-5D-5L in other respiratory diseases.Results: 101 patients...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Clinical Problems Asthma Source Type: research
The patient is a 22-year-old man with a history of common variable immunodeficiency (CVID) associated with a heterozygous mutation in TNFRSF13B (TACI), granulomatous lymphocytic interstitial lung disease (GLILD), massive splenomegaly, immune thrombocytopenia, and autoimmune hemolytic anemia. He presented with a 5-day history of fever with temperatures up to 38.9 °C, malaise, sinus congestion, intermittent headaches, and loose stools. He had no cough, dyspnea, vomiting, abdominal pain, joint pain, or rash.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Challenging Clinical Cases Source Type: research
Ruth E Wiggans (REW): A 52-year-old man was referred with chronic cough of increasing severity over the last 4 years. The cough was productive of green sputum and he experienced coughing attacks weekly. He reported no other respiratory symptoms. He had a sore throat following coughing bouts but denied other upper airway complaints. He was otherwise well with no systemic symptoms. His cough had improved following a 2-week summer holiday, and subsequently deteriorated following his return to work. A chest X-ray organised in primary care was normal. Three years earlier, his general practitioner increased his lansoprazole...
Source: Thorax - Category: Respiratory Medicine Authors: Tags: Open access, General practice / family medicine, TB and other respiratory infections, Asthma, Bronchitis, Interstitial lung disease, Radiology (diagnostics) Chest clinic Source Type: research
CONCLUSION: To our knowledge, this is the first case of asthma and CEP in a patient taking adalimumab (a TNF-inhibitor). Our patient likely had eosinophilic asthma phenotype, which works through the Th2 cell pathway. His psoriasis, which is primarily a Th1 cell pathway disease, likely masked his asthma most of his life. Once on adalimumab, the Th1 response was suppressed and the Th2 pathway was unmasked-revealing itself clinically as asthma. The events that led to the diagnosis of asthma were unknown. However, his symptoms began after starting adalimumab and may explain the chronic pulmonary changes and the possibility tha...
Source: Journal of Asthma - Category: Respiratory Medicine Tags: J Asthma Source Type: research
S Bajaj, M Muranjan, S Karande, D PrabhatJournal of Postgraduate Medicine 2017 63(2):122-127Pulmonary manifestations are seldom recognized as symptoms of storage disorders. The report describes the diagnostic journey in a 30-month-old male infant, born of a third-degree consanguineous marriage referred to our institute as severe persistent asthma. History revealed that the child had progressively worsening breathlessness and persistent dry cough not associated with fever but accompanied by weight loss. On physical examination, there was growth failure, respiratory distress, clubbing, hepatosplenomegaly, and occasional rhon...
Source: Journal of Postgraduate Medicine - Category: Internal Medicine Authors: Source Type: research
More News: Asthma | Corticosteroid Therapy | Cough | CT Scan | Interstitial Lung Disease | PET Scan | Radiography | Respiratory Medicine | Spirometry