title: Common variable immunodeficiency diagnosed during the treatment of bronchial asthma: Unusual cause of wheezing.
abstract: Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency in adults and children. We herein report a case of CVID, who was misdiagnosed with asthma due to wheezing episodes and relatively late onset. A 51-year-old woman had suffered from recurrent upper and lower airway infection for recent 2 years. She repeated wheezing attacks and was treated as asthma exacerbation triggered by infection. She was referred to our hospital for investigation and treatment. Lung function tests showed no reversibility of FEV1 by β-adrenergic agonist, but the increase of V50/V25. Chest CT showed slight to moderate bronchial wall thickening and bronchiectasis. After that, she suffered from pneumonia with wheezing attacks twice a month, and immunodeficiency was strongly suspected. Her blood tests showed marked decreases of all classes of immunoglobulin and nearly lack of memory B cells, NKT cells and plasmacytoid dendritic cells. She was diagnosed with CVID, and was treated with replacement of gammaglobulin. Thereafter, her wheezing episodes with infection were remarkably improved. Because the delay of diagnosis with CVID likely causes poor mortality and morbidity, a possibility of CVID should be considered in patients with frequent asthma-like symptoms due to recurrent airway infection.
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Akaba
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Kondo
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Toriyama
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Kubo
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Hara
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshinaga
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tamaoki
keywords: Airway infection; Bronchial asthma; Common variable immunodeficiency; Hypogammaglobulinemia; Primary immunodeficiency; Wheezes