A Case of Inflammatory Bowel Disease and Common Variable Immunodeficiency.
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Shahab Virani, MD, Praveen Govender, MD
Rationale: Common Variable Immunodeficiency ( CVID) has a multitude of clinical manifestations. We present a case that had both recalcitrant infectious complication and inflammatory bowel disease (IBD) related to an undefined primary immunodeficiency consistent with CVID.

Methods: esophagogastroduodenoscopy ( EGD) and colonoscopy, immunodeficiency evaluation.

Results: A 38 year old woman presented 3 years ago with persistent bilateral lower quadrant pain, nausea, vomiting and diarrhea.  In her initial workup, EGD and colonoscopy demonstrated scalloping and cobble stoning of duodenum, and multiple ulcerations with colitis throughout the duodenum and colon. Pathology of the duodenum and ileum showed partial villous atrophy with reactive lymphoid follicles in the lamina propria. Colonic pathology showed intraepithelial lymphocytosis with reactive lymphoid follicles. Plasma cells were absent in the small bowel and rarely seen in the colon. This histological feature, in conjunction with giardiasis and campylobacter infections raised the potential diagnosis of CVID.  Serologic immunodeficiency evaluation confirmed the diagnosis with low serum immunoglobulins and impaired response to polysaccharide antigens only. Her clinical course was dominated by recalcitrant giardiasis infection that failed to resolve despite numerous antimicrobial regimens and commencement of IVIG. However, upon initiation of oral steroids her GI symptoms markedly improved, the chronic infection was eradicated and IBD improved with restoration of the architectural changes seen on pre-treatment biopsies. 

Conclusions: There is little literature on gastrointestinal manifestations of CVID. We present a patient with both infectious and inflammation bowel disease related to CVID and show that treatment of the IBD with steroids was required to help eradicate the chronic giardial infection.