Multimodal immunosuppressant therapy in steroid-refractory common variable immunodeficiency sprue: a case report complicating cytomegalovirus infection

Int J Surg Pathol. 2006 Jan;14(1):101-6. doi: 10.1177/106689690601400120.

Abstract

Immunodeficient patients can develop malabsorption, mimicking celiac disease clinically and histologically. Such individuals may also occasionally require immunosuppressive therapy for autoimmune disorders. We have identified a patient with common variable immunodeficiency (CVID)-associated sprue complicated by duodenal cytomegalovirus (CMV) infection following corticosteroid and ancillary immunomodulatory therapy. Ganciclovir and a modification of the immunosuppressant regimen improved both clinical symptoms and villous atrophy. To our knowledge, this is original documentation of duodenal CMV infection secondary to immunomodulatory therapy for steroid-refractory CVID-sprue.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Antibodies, Monoclonal / therapeutic use
  • Antiviral Agents / therapeutic use
  • Azathioprine / therapeutic use
  • Celiac Disease / complications*
  • Celiac Disease / diagnosis
  • Celiac Disease / drug therapy*
  • Common Variable Immunodeficiency / complications*
  • Common Variable Immunodeficiency / diagnosis
  • Common Variable Immunodeficiency / drug therapy*
  • Cytomegalovirus / isolation & purification
  • Cytomegalovirus Infections / complications*
  • Cytomegalovirus Infections / diagnosis
  • Cytomegalovirus Infections / drug therapy
  • Diagnosis, Differential
  • Drug Resistance
  • Duodenum / drug effects
  • Duodenum / pathology
  • Duodenum / virology
  • Female
  • Ganciclovir / therapeutic use
  • Humans
  • Immunologic Factors / therapeutic use
  • Immunosuppressive Agents / therapeutic use*
  • Infliximab
  • Lymphoma, T-Cell / diagnosis
  • Lymphoma, T-Cell / etiology
  • Lymphoma, T-Cell / pathology
  • Middle Aged
  • Prednisone / therapeutic use
  • Steroids / therapeutic use*

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal
  • Antiviral Agents
  • Immunologic Factors
  • Immunosuppressive Agents
  • Steroids
  • Infliximab
  • Azathioprine
  • Ganciclovir
  • Prednisone