Pulmonary findings in common variable immunodeficiency (CVID)

It is not clear if interstitial lung disease (ILD) in common variable immunodeficiency (CVID) is a consequence of chronic infection or a manifestation of dysregulated lymphoid proliferation.

This retrospective review of electronic medical records of 61 patients with CVID evaluated clinical and laboratory correlates of bronchiectasis, ground glass opacity, and pulmonary nodules on CT scan.

Here are the correlations:

- Bronchiectasis was strongly correlated with a CD4+ T-cell count lower than 700 cells/μL and was associated with a history of pneumonia and older age.

- Pulmonary nodular disease was correlated with increased CD4+:CD8+ T-cell ratios, a history of autoimmune hemolytic anemia or immune thrombocytopenic purpura, elevated IgM, and younger age.

- Ground glass opacity had similar clinical and laboratory characteristics as those for nodular lung disease but was associated with elevated monocyte counts and the presence of liver disease.

Bronchiectasis were more strongly associated with infection and T-cell lymphopenia. ILD was more strongly linked with autoimmunity and lymphoproliferation.

References:

Pulmonary radiologic findings in common variable immunodeficiency: clinical and immunological correlations. Maglione PJ1, Overbey JR2, Radigan L1, Bagiella E2, Cunningham-Rundles C3. Ann Allergy Asthma Immunol. 2014 May 28. pii: S1081-1206(14)00297-X. doi: 10.1016/j.anai.2014.04.024. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/24880814