title: Pulmonary radiologic findings in common variable immunodeficiency: clinical and immunological correlations.
abstract: BACKGROUND
  It remains unclear whether interstitial lung disease (ILD) in common variable immunodeficiency (CVID) is a consequence of chronic infection or a manifestation of dysregulated lymphoid proliferation found in those with this condition.
  
  
  OBJECTIVE
  To increase understanding of CVID-associated lung disease by comparing clinical and immunologic associations in those with bronchiectasis, ILD, or no lung disease observed on chest computerized tomography (CT).
  
  
  METHODS
  Retrospective review of electronic medical records of 61 patients with CVID was used to identify clinical and laboratory correlates of bronchiectasis, ground glass opacity, and pulmonary nodules on CT scan.
  
  
  RESULTS
  Significant clinical and immunologic associations were identified for common CT scan findings in CVID. 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.
  
  
  CONCLUSIONS
  CT findings of bronchiectasis or ILD, including ground glass opacity and extensive pulmonary nodules, were correlated with selected clinical and laboratory characteristics. These results suggest divergent processes of CVID lung disease, with bronchiectasis more strongly associated with infection and T-cell lymphopenia and ILD more strongly linked with autoimmunity and lymphoproliferation.
authors.affiliation: Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Maglione
authors.affiliation: Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Overbey
authors.affiliation: Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Lin
authors.initials: L
authors.lastname: Radigan
authors.affiliation: Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Emilia
authors.initials: E
authors.lastname: Bagiella
authors.affiliation: Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: Charlotte.Cunningham-Rundles@mssm.edu.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Cunningham-Rundles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000276:immunology; D001987:Bronchiectasis / Q000000981:diagnostic imaging* / Q000276:immunology; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D017074:Common Variable Immunodeficiency / Q000000981:diagnostic imaging*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008168:Lung / Q000000981:diagnostic imaging; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000276:immunology; D011014:Pneumonia / Q000276:immunology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D007075:Immunoglobulin M