Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA
Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA.
BMJ Case Rep. 2021 Feb 5;14(2):e239733. doi: 10.1136/bcr-2020-239733.
The patient is a 64-year-old Caucasian woman with idiopathic chronic urticaria who presented to her primary care physician's office with mucoid otitis media. Medical history was significant for hypertension, hyperlipidaemia, allergic rhinitis, pre-diabetes, gastro-oesophageal reflux, paroxysmal atrial fibrillation, chronic kidney disease, diverticulosis with prior diverticulitis and history of recurrent infections. Her chronic urticaria was initially treated with antibiotics, antihistamines and oral steroids, but later she developed refractory urticaria requiring dapsone with modest improvement. When she presented with mucoid otitis media, immunoglobulin levels were found to be decreased. The pneumococcal vaccine antibody challenge confirmed the diagnosis of common variable immunodeficiency (CVID). Her HIV test was negative. She was started on intravenous immunoglobulin infusions and her chronic urticaria stabilised.In patients with chronic urticaria refractory to treatment, especially with a history of recurrent infections, a diagnosis of CVID should be considered, regardless of HIV status.
患者是一位 64 岁的白人女性，患有特发性慢性荨麻疹，因黏液性中耳炎到初级保健医生办公室就诊。既往病史包括高血压、高脂血症、过敏性鼻炎、前驱糖尿病、胃食管反流、阵发性心房颤动、慢性肾脏病、憩室病伴憩室炎病史和反复感染史。她的慢性荨麻疹最初用抗生素、抗组胺药和口服类固醇治疗，但后来她发展为难治性荨麻疹，需要使用达普松治疗，病情略有改善。当她出现黏液性中耳炎时，发现免疫球蛋白水平降低。肺炎球菌疫苗抗体挑战证实了普通可变免疫缺陷（CVID）的诊断。她的 HIV 检测结果为阴性。她开始接受静脉注射免疫球蛋白输注治疗，慢性荨麻疹稳定。对于治疗无效的慢性荨麻疹患者，尤其是有反复感染史的患者，无论 HIV 状态如何，都应考虑 CVID 的诊断。
