SHM Converge Scientific Abstract ePoster Gallery-Common Variable Immunodeficiency: Considerations for Variations in Symptomatology

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A 67-year-old woman was admitted for months of fluctuating mental status changes, intermittent fevers, and diaphoresis. Her history included CHF, OSA, and chronic abdominal pain after ventral mesh hernia repair in 2019 complicated by fistulization and prior abscess. On arrival she was afebrile and stable. Initial labs showed elevated CRP, low-normal selenium, and otherwise unrevealing infectious, hepatic, thyroid, and blood/urine studies. Exam revealed three vesicular lesions on the right arm and significant superficial dehiscence of the prior abdominal surgical scar with right lower quadrant tenderness. CT abdomen/pelvis showed intact mesh repair without acute intraabdominal pathology.<br /><br />Because of persistent unexplained symptoms and abnormal wound healing, additional history uncovered recurrent fevers, diaphoresis, and poor wound healing. Immunologic workup showed markedly low IgG with low IgG subclasses, borderline low IgM, normal IgA, and decreased total memory B cells with reduced switched and non-switched memory B-cell subsets. SPEP and monoclonal gammopathy evaluation were negative.<br /><br />She was diagnosed with common variable immunodeficiency (CVID) and started on IVIG during hospitalization, with plans for outpatient monitoring of IgG levels. The case emphasizes that CVID does not always present with recurrent infections; it can also manifest with skin findings, chronic nonhealing wounds, constitutional symptoms, autoimmune disease, gastrointestinal inflammation, chronic lung disease, or malignancy. In this patient, the diagnosis was prompted by atypical inpatient complaints and skin/wound abnormalities rather than classic recurrent infections.

Asset Subtitle

Parth S. Patel

Meta Tag

Author List Kevin Stanko, Parth S. Patel, Richa Shah

Category Clinical Vignettes

Concept Common Variable Immunodeficiency

Concept Immunoglobulin G

Concept Intravenous Immunoglobulin

Concept Memory B Cell

Concept Immunologic Evaluation

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Parth S. Patel

Track Adult

Keywords

common variable immunodeficiency

CVID

hypogammaglobulinemia

IVIG therapy

nonhealing wound

recurrent fevers

diaphoresis

memory B cells

IgG subclasses

immune deficiency

Common Variable Immunodeficiency

Immunoglobulin G

Intravenous Immunoglobulin

Memory B Cell

Immunologic Evaluation