Fever of unknown origin in a patient with common variable immunodeficiency associated with multisystemic granulomatous disease.
Non-caseating epithelioid granulomas have been described in a small number of patients with common variable immunodeficiency (CVID). We report a 26-year-old woman diagnosed with CVID nine years earlier, who developed non-caseating granulomas in the liver, bone marrow and skin. She was referred to our department for a fever of more than one year duration without apparent focus. Extensive search for underlying malignancy or occult infection was unremarkable. Empirical treatment with prednisone was begun and the patient showed a marked improvement. The literature on the association between CVID and non-caseating granulomatous disease, and the differential diagnosis of hepatic granulomas as a cause of fever of unknown origin, is also reviewed.
Department of Internal Medicine, Hospital Universitario, Madrid, Spain. mario_fdezruiz@yahoo.es
Mario
M
Fernández-Ruiz
Juan-Manuel
JM
Guerra-Vales
Castelbón-Fernández
CF
Francisco-Javier
Rodriguez-Gil
RG
Yolanda
Martánez-González
MG
Miguel-Ingel
Garfia-Castillo
GC
Cristina
Ruiz-Contreras
RC
Jesús
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D017074:Common Variable Immunodeficiency / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000188:drug therapy / Q000209:etiology*; D006099:Granuloma / Q000150:complications / Q000175:diagnosis; D006105:Granulomatous Disease, Chronic / Q000150:complications* / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis; D011241:Prednisone / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000893:Anti-Inflammatory Agents; D011241:Prednisone