The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.
The HRB funded Clinical Research Facility, University College Cork, Cork, Ireland.
J Asthma. 2022 Jun;59(6):1177-1180. doi: 10.1080/02770903.2021.1922913. Epub 2021 May 8.
Common variable immunodeficiency is characterized by impaired B-cell differentiation and defective immunoglobulin production manifesting as recurrent respiratory tract infections. While the condition can masquerade as asthma, late diagnosis of CVID in known asthmatic is rarely reported. We present the case of a 43-year-old lady with recurrent episodes of wheeze, cough, sinusitis and multiple lower respiratory tract infections. Transiently responsive to antibiotics and steroids. These episodes had been occurring for many years and she had a longstanding clinical diagnosis of asthma. As part of her work up for recurrent respiratory tract infections a CT thorax was performed and demonstrated bronchiectasis. Further tests including Immunoglobulin levels revealed critically low IgG, IgM, and IgA levels. Immunoglobulin replacement therapy was commenced with a reduction in exacerbation frequency and severity, and objective improvement of asthma control. Subsequent lung function tests demonstrated reversible airflow limitation (obstructive lung function with 13% reversibility in FEV post-bronchodilator) consistent with asthma. Our case illustrates the importance of searching for alternate and co-existent diagnoses in patients diagnosed with asthma who are unresponsive to conventional therapy. We believe that serum immunoglobulin measurement should form a component of such a workup.
常见变异性免疫缺陷的特征是 B 细胞分化受损和免疫球蛋白产生缺陷，表现为反复呼吸道感染。虽然这种情况可能表现为哮喘，但在已知哮喘的患者中，迟发性 CVID 诊断很少见。我们报告了一例 43 岁女性，反复出现喘息、咳嗽、鼻窦炎和多次下呼吸道感染。对抗生素和类固醇有短暂反应。这些发作已经持续多年，她被临床诊断为哮喘。作为反复呼吸道感染检查的一部分，进行了胸部 CT 检查，显示支气管扩张。进一步的检查包括免疫球蛋白水平，发现 IgG、IgM 和 IgA 水平严重降低。开始进行免疫球蛋白替代治疗，减少了发作频率和严重程度，并客观改善了哮喘控制。随后的肺功能检查显示可逆转的气流受限（支气管扩张剂后 FEV 有 13%的可逆转性，提示阻塞性肺功能），符合哮喘的特征。我们的病例说明了在对常规治疗反应不佳的哮喘患者中寻找其他并存诊断的重要性。我们认为，血清免疫球蛋白测量应该成为这种检查的一部分。
