Non-Sarcoidal, Non-Tuberculoid Granuloma in Common Variable Immunodeficiency
April 2006 | Volume 5 | Issue 4 | Case Report | 370 | Copyright © 2006
M.B. Abdel-Naser, U. Wollina MD, M.A. El Hefnawi, M.A. Habib, M. El Okby
Sarcoidal (non-caseating) or tuberculoid granulomas are cutaneous manifestations of common variable immunodeficiency (CVID). In this case report, we describe a patient with CVID but with non-sarcoidal, non-tuberculoid granuloma. The 29- year-old Egyptian male patient presented with a vitiliginous patch on the chin of 1 year duration and multiple recurrent warts on the hands and feet of 8 years duration. He is a known case of CVID with chronic diarrhea, recurrent otitis media, pneumonia, purulent conjunctivitis, septic arthritis, hepato-splenomegaly, and generalized lymphadenopathy. In addition, he had evidence of multiple non-tender subcutaneous nodules predominantly juxta-articular and recurrent rheumatoid-like arthritis. The skin overlying the nodules was either normal or slightly erythematous. Laboratory findings revealed markedly reduced serum immunoglobulins (IgG 3.4, n=7.2-16.9 g/l; IgA 0.1, n=0.69-3.82 g/l and IgM 0.1, n=0.63-2.77 g/l) and deficient T cell function. Histopathologic examination of a skin nodule showed well demarcated areas of fibrinoid degeneration of collagen that stain homogeneously and are surrounded by histiocytes in a palisading arrangement, suggestive of granuloma annulare. No microorganisms could be detected. Serology for rheumatoid factor and HIV infection has been persistently negative. Although most infections, including common warts responded well to intravenous immunoglobulin replacement thrapy (12 g/i.v., every 2 weeks) and oral board spectrum antibiotic therapy, the subcutaneous nodules persisted. The vitiliginous patch responded favorably and disappeared within 24 local PUVA sessions. Since skin nodules are asymptomatic, no further treatment was given.
Purchase Original Article
Purchase a single fully formatted PDF of the original manuscript as it was published in the JDD.
Download the original manuscript as it was published in the JDD.
Contact a member of the JDD Sales Team to request a quote or purchase bulk reprints, e-prints or international translation requests.
To get access to JDD's full-text articles and archives, upgrade here.
Save an unformatted copy of this article for on-screen viewing.
Print the full-text of article as it appears on the JDD site.→ proceed | ↑ close