Respir Case Rep. 2015; 4(1): 13-18 | DOI: 10.5505/respircase.2015.04695

A Case with a Considerably Delayed Diagnosis: Common Variable Immunodeficiency

Fatma Tokgöz, Emine Aksoy, Yasemin Bodur, Tülin Sevim
Department of Pulmonology, Süreyyapaþa Chest Diseases and Thoracic Surgery Training and Research Hospital, Ýstanbul, Turkey

Common variable immunodeficiency (CVID) is the most common clinically important primary immuno-deficiency that is characterized by frequent bacterial infections, autoimmune diseases, and increased incidence of malignancy. CVID can cause bronchiectasis, interstitial involvement, nodular formations, granulomatous disease, and interstitial pneumonia. A 31-year-old male patient who had a history of pernicious anemia, Hashimoto's thyroiditis, and gastric carcinoma diagnosed six years ago, was admitted to our clinic. He had undergone gastrectomy and was cured. In the first year of follow-up in the oncology clinic, lung nodules were detected and chemotherapy was administered. After chemotherapy, new nodules were accepted as metastasis and he was referred to a tertiary center for diagnosis. We hospitalized the case for further investigation. The tomographic imaging showed remarkable bronchiectasis accompanied by multiple nodules that were migrating compared to the previous images. Serum immunoglobulin levels decreased and he was diagnosed with CVID. The case, rarely seen and diagnosed quite late, is presented in the light of the literature.

Keywords: Bronchiectasis, common variable immunodeficiency, nodule.

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Tanýsý Oldukça Gecikmiþ Bir Olgu: Sýk Deðiþken Ýmmün Yetmezlik

Fatma Tokgöz, Emine Aksoy, Yasemin Bodur, Tülin Sevim
Süreyyapaþa Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi, Göðüs Hastalýklarý Kliniði, Ýstanbul

Sýk deðiþken immün yetmezlik (SDÝY) immünglobulin üretiminde defekt ile karakterize, klinik önemi olan en sýk primer immün yetmezliktir. Tekrarlayan bakteriyel enfeksiyonlar, otoimmün hastalýklar ve malignite insidansýnda artýþ ile seyreder. Akciðerde bronþektazi, interstisyel tutulum, nodüler oluþumlar, granülomatöz hastalýk ve interstisyel pnömoniye neden olabilir. Öyküsünde pernisiyöz anemi, hashimato tiroiditi, 6 yýl önce taný konulmuþ mide karsinomu bulunan 31 yaþýnda erkek olgu kliniðimize baþvurdu. Olguya gastrektomi uygulanmýþ, kür olmuþ ve onkolojik takibinde ilk yýlda akciðerde nodüller saptanarak kemoterapi uygulanmýþtý. Kemoterapi sonrasýnda akciðer görüntülemelerinde yeni nodüller geliþmiþ ve metastaz olduðu düþünülerek takibe devam edilmiþti. Takiplerde nodüllere taný amaçlý ileri merkeze yönlendirilmiþti. Kliniðimizde çekilen tomografide nodüllerin yer deðiþtirdiði ve bronþektazilerin eþlik ettiði görüldü ve immünoglobulinlerinde düþüklük saptandý. SDÝY tanýsý konularak immünoloji bölümüne yönlendirildi. Nadir görülen, tanýsý oldukça gecikmiþ olan olgu, literatürler eþliðinde sunuldu.

Anahtar Kelimeler: Bronþektazi, nodül, sýk deðiþken immün yetmezlik.

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