Yonsei Med J.  2005 Dec;46(6):847-850.

Association of Secondary Amyloidosis with Common Variable Immune Deficiency and Tuberculosis

• Celik AF
• Altiparmak MR
• Pamuk GE
• Pamuk ON
• Tabak F

Abstract

This paper describes the first case of common variable immunodeficiency (CVID) and AA amyloidosis. A recently treated tuberculosis, and chronic inflammation induced by frequent respiratory tract infections, were thought to be responsible for the amyloidosis. No other reason for this condition could be detected. Although T cell dysfunction in some CVID patients has been reported, pulmonary tuberculosis is quite rare with this condition. Bacterial or viral agents or evidence in favour of intestinal tuberculosis, which would explain this patient's recurrent diarrhea, were not found. In this case, the response of the attacks of diarrhea to metranidazole and the histologic observation of extensive intestinal amyloid deposition, which is known to decrease intestinal motility, made us conclude that the diarrhea was associated with bacterial overgrowth. In this report, we discuss the association of CVID and tuberculosis to secondary amyloidosis and recurrent diarrhea.

Keyword

Common variable immunodeficiency; secondary amyloidosis; tuberculosis; diarrhea

MeSH Terms

Tuberculosis/*complications
Male
Humans
Diarrhea/etiology
Common Variable Immunodeficiency/*complications
Amyloidosis/*etiology/pathology
Adult

Figure

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  Fig. 1 Massive amyloid deposition beneath the surface epithelium (Congo-red × 200).

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  Fig. 2 Extensive amyloid deposition is visible among the crypts of the lamina propria and in the deep mucosa. (Congo-red × 200).

Reference

1. Sneller MC, Strober W, Eisenstein E, Jaffe JS, Cunningham-Rundles C. NIH conference. New insights into common variable immunodeficiency. Ann Intern Med. 1993. 118:720–730.

2. Hermans PE, Diaz-Buxo JA, Stobo JD. Idiopathic late onset immunoglobulin deficiency. Clinical observations in 50 patients. Am J Med. 1976. 61:221–232.

3. Cunningham-Rundles C. Clinical and immunologic analysis of 103 patients with common variable immunodeficiency. J Clin Immunol. 1989. 9:22–33.

4. Washington K, Stenzel TT, Buckley RH, Gottfried MR. Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. Am J Surg Pathol. 1996. 20:1240–1252.

5. Byrne MF, Royston D, Patchett SE. Association of common variable immunodeficiency with atypical collagenous colitis. Eur J Gastroenterol Hepatol. 2003. 15:1051–1053.

6. Tanus T, Levinson AI, Atkins PC, Zweiman B. Polyautoimmune syndrome in common variable immunodeficiency. J Intern Med. 1993. 234:525–527.

7. Yocum MW, Kelso JM. Subspecialty clinics: Common variable immunodeficiency: the disorder and treatment. Mayo Clin Proc. 1991. 66:83–96.

8. Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999. 92:34–48.

9. Ament ME, Rubin CE. Relation of giardiasis to abnormal intestinal structure and function in gastrointestinal immunodeficiency syndromes. Gastroenterology. 1972. 62:216–226.

10. Bely M, Apathy A. Disease modifying factors in chronic polyartritis. Correlations among systemic vasculitis, secondary amyloidosis, septic infections and occurrence of miliary epitheloid-cell granuloma. A review of autopsies. Zentralbl Pathol. 1993. 139:51–60.

11. Urban BA, Fishman EK, Goldman SM, Scott WW Jr, Jones B, Humphrey RL, et al. CT evaluation of amyloidosis:spectrum of disease. Radiographics. 1993. 13:1295–1308.

12. Hamer DH, Gorbach SL. Feldman M, Scharsschmidt BF, Sleisenger MH, editors. Infectious diarrhea and bacterial food poisoning. Gastrointestinal and liver disease. 1998. 6th ed. Philadelphia: W.B. Saunders Company;1594–1632.

13. Kagnof MS. Feldman M, Scharsschmidt BF, Sleisenger MH, editors. Immunology and inflammation of the gastrointestinal tract. Gastrointestinal and liver disease. 1998. Sixth ed. Philadelphia: W.B. Saunders Company;19–48.

14. Gries E, Singer MV, Goebell H. Amyloidosis in Crohn disease. Case reports and review of the literature. Med Klin (Munich). 1989. 84:65–71.

15. Friedman S, Janowitz HD. Systemic amyloidosis and the gastrointestinal tract. Gastroenterology Clin North Am. 1998. 27:595–614.

16. Cathcart ES. Kelley WN, Harris ED, Ruddy S, Sledge CB, editors. Amyloidosis. Textbook of Rheumatology. 1993. Philadelphia: W.B. Saunders Company;1413–1428.

17. Feurle GE. Pathophysiology of diarrhea in patients with familial amyloid neuropathy. Digestion. 1987. 36:13–17.