The Central Nervous System Effects and Mimicry of Common Variable Immunodeficiency (CVID): A Case Report with Literature Review.
Journal
Case reports in rheumatology
ISSN: 2090-6889
Titre abrégé: Case Rep Rheumatol
Pays: United States
ID NLM: 101585353
Informations de publication
Date de publication:
2019
2019
Historique:
received:
15
02
2019
revised:
26
08
2019
accepted:
17
09
2019
entrez:
31
10
2019
pubmed:
31
10
2019
medline:
31
10
2019
Statut:
epublish
Résumé
There is a scarceness of information on the central nervous system effects of common variable immunodeficiency (CVID). A 30-year-old woman with a history of recurrent upper respiratory infections, vitiligo, and immune thrombocytopenic purpura presented with right-sided numbness. Magnetic resonance imaging (MRI) of the thoracic spine revealed a signal hyperintensity. MRI of the brain demonstrated FLAIR hyperintensity in the right middle frontal gyrus. Cerebral spinal fluid was unremarkable. Serum immunoglobulins revealed hypogammaglobulinemia. Endobronchial and subsequent mediastinum biopsies were all negative for sarcoidosis and malignancy. No infectious etiology was found. She was treated with glucocorticoids and intravenous immunoglobulin (IVIG) replacement therapy for CVID-associated myelitis. Follow-up MRI showed improvement; however, her numbness persisted despite these treatments, which led to an outside physician adding methotrexate for their suspicion of sarcoidosis. Her symptoms remained stable for two years, but when the methotrexate dose was weaned, her numbness worsened. Upon review, the treatment team refuted the diagnosis of sarcoidosis but continued treatment with prednisone, IVIG, and methotrexate for CVID-associated myelitis, from which her symptoms have stabilized. Here, we discuss CVID-associated neurological complications, its similarities to sarcoidosis, and a literature review with treatment regimens and outcomes.
Identifiants
pubmed: 31662938
doi: 10.1155/2019/7623643
pmc: PMC6791247
doi:
Types de publication
Case Reports
Langues
eng
Pagination
7623643Informations de copyright
Copyright © 2019 Sohail Farshad et al.
Déclaration de conflit d'intérêts
The authors declare that they have no conflicts of interest.
Références
EBioMedicine. 2016 Jun;8:302-308
pubmed: 27428439
Clin Immunol. 2004 Jul;112(1):24-9
pubmed: 15207778
J Clin Immunol. 2016 Nov;36(8):793-800
pubmed: 27704236
Discov Med. 2013 Oct;16(88):167-77
pubmed: 24099672
Clin Immunol. 2002 Jan;102(1):19-24
pubmed: 11781063
Arthritis Res Ther. 2017 May 18;19(1):101
pubmed: 28521808
J Neurol. 2008 Nov;255(11):1821-4
pubmed: 18677641
J Clin Pathol. 2010 Mar;63(3):275-7
pubmed: 20203231
Pract Neurol. 2015 Feb;15(1):49-52
pubmed: 25335879
BMJ Case Rep. 2012 Aug 08;2012:null
pubmed: 22878981