title: Cytomegalovirus disease in patients with common variable immunodeficiency: three case reports.
abstract: Common variable immunodeficiency (CVID) is the most frequent clinically relevant primary immunodeficiency and shows enormous heterogeneity in clinical presentation. Despite clinical immunodeficiency, opportunistic infections are not a typical manifestation of CVID. A retrospective study of 32 patients followed up for 335 patient-years was performed to determine the frequency of cytomegalovirus (CMV) disease. Symptomatic CMV infection was documented in 3 CVID patients. Patients No. 1 and 2 suffered from CMV pneumonia, with complications due to atypical mycobacteriosis in patient No. 1. Patient No. 3 suffered from CMV enteritis. A history of cancer and chronic hepatitis C infection (patient No. 1), immunosuppressive therapy for interstitial lung disease (patient No. 2) and serious enteropathy complicated with malnutrition (patient No. 3) may have contributed to the complications despite only mild abnormalities in T-cell subpopulations. The direct detection of CMV in bronchoalveolar lavage, stool or tissue samples was the most beneficial diagnostic laboratory method, whereas the detection of CMV DNA in blood did not produce positive results. Adequate treatment of CMV disease led to significant clinical improvement in all 3 patients. The frequency of CMV disease appears to be higher than previously described. In our experience, the probability of opportunistic infections in CVID patients increases with secondary comorbidities and their management.
authors.affiliation: Institute of Clinical Immunology and Allergy, University Hospital Hradec Kralove, Faculty of Medicine, Charles University in Prague, Hradec Kralove, Czech Republic.
authors.forename: Pavlina
authors.initials: P
authors.lastname: Kralickova
authors.forename: Eva
authors.initials: E
authors.lastname: Mala
authors.forename: Doris
authors.initials: D
authors.lastname: Vokurkova
authors.forename: Irena
authors.initials: I
authors.lastname: Krcmova
authors.forename: Lenka
authors.initials: L
authors.lastname: Pliskova
authors.forename: Vlasta
authors.initials: V
authors.lastname: Stepanova
authors.forename: Vladimir
authors.initials: V
authors.lastname: Bartos
authors.forename: Vladimir
authors.initials: V
authors.lastname: Koblizek
authors.forename: Ilja
authors.initials: I
authors.lastname: Tacheci
authors.forename: Jan
authors.initials: J
authors.lastname: Bures
authors.forename: Jan
authors.initials: J
authors.lastname: Brozik
authors.forename: Jiri
authors.initials: J
authors.lastname: Litzman
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D017074:Common Variable Immunodeficiency / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000302:isolation & purification*; D004751:Enteritis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D011024:Pneumonia, Viral / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
chemical_list: D004279:DNA, Viral