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Williams A, Kelleher WP, Nicholson AG, Devaraj A, Pavesio C, Chua F. Diffuse granulomatous disease: looking inside and outside the lungs. Thorax 2020; 75:189-191. [PMID: 31907202 PMCID: PMC7029226 DOI: 10.1136/thoraxjnl-2019-213797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Alan Williams
- Interstitial Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Felix Chua
- Interstitial Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Coussa RG, Antaki F, Lederer DE. HLA-A29 negative Birdshot-like chorioretinopathy associated with common variable immunodeficiency. Am J Ophthalmol Case Rep 2018; 10:18-24. [PMID: 29780906 PMCID: PMC5956626 DOI: 10.1016/j.ajoc.2018.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 12/27/2017] [Accepted: 01/10/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the longest ophthalmic follow-up and the associated ocular complications of HLA-A29 negative Birdshot-like chorioretinopathy (BLCR) associated with common variable immunodeficiency (CVID). Observations A 22-year-old man known for CVID presented with a 3-month history of decreased visual acuity OS. Funduscopy revealed significant cystoid macular edema OS, as well as optic disk edema and chorioretinal infiltrates without signs of vitritis OU. No infectious, inflammatory or neoplastic etiologies were identified. He subsequently received one dose of intravitreal triamcinolone OS which completely resolved the macular edema. The optic nerve edema persisted despite the addition of intravenous immunoglobulin. His visual acuity was 20/20 OU at the 24th follow-up month. Conclusion and importance: To our knowledge, this is the third case of HLA-A29 negative BLCR associated with CVID. It is the first case with long-term follow-up providing, in consequence, the best understanding of the natural history and possible complications of this rare disease. Aggressive systemic treatment, in collaboration with an immunologist, is generally needed to control the ophthalmic complications.
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Affiliation(s)
- Razek Georges Coussa
- Department of Ophthalmology, McGill Academic Eye Centre, 5252 Boulevard de Maisonneuve West, 4th Floor, Montréal, Québec H4A 3S5, Canada
| | - Fares Antaki
- Department of Ophthalmology, McGill Academic Eye Centre, 5252 Boulevard de Maisonneuve West, 4th Floor, Montréal, Québec H4A 3S5, Canada
| | - David E Lederer
- Department of Ophthalmology, McGill Academic Eye Centre, 5252 Boulevard de Maisonneuve West, 4th Floor, Montréal, Québec H4A 3S5, Canada
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Stenton S, Fernando M, Currie Z, Mudhar HS. Metachronous Diffuse Large B-Cell Lymphoma and Kaposi Sarcoma of the Right Eyelid and Lacrimal Gland in a Patient with Granulomatous Common Variable Immunodeficiency. Ocul Oncol Pathol 2016; 2:197-201. [PMID: 27239466 DOI: 10.1159/000444261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 01/18/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To describe the ophthalmic and histopathological features of a female with granulomatous common variable immunodeficiency (CVID) who presented with upper-lid swelling. PROCEDURES The patient underwent a biopsy of the right upper lid/palpebral lacrimal gland with imaging showing a left-sided nasopharyngeal mass, multiple lymph nodes within the mediastinum, bilateral lung nodules and a peritoneal nodule in the right iliac fossa. The right upper-lid swelling progressed and was subject to a second biopsy. RESULTS The first right upper-lid biopsy revealed a diffuse large B-cell lymphoma (DLBCL), confirmed with clonal IgH gene rearrangement with PCR. The nasopharyngeal mass and lymph nodes were suspected clinically to be DLBCL. However, a biopsy of the nasopharyngeal mass showed Kaposi sarcoma (KS). The second biopsy of the right upper lid/palpebral lacrimal gland revealed KS with no evidence of DLBCL. CONCLUSION This is the first documentation of periocular/orbital metachronous DLBCL and KS in a patient with granulomatous CVID. We discuss the role of fluctuating immunity in CVID to explain the spontaneous regression of the DLBCL and the varying clinical picture.
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Affiliation(s)
- Sophie Stenton
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Malee Fernando
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Zanna Currie
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
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Oh J, Marks AL, Wessell KR, Tcheurekdjian H, Venglarcik J, Singerman LJ, Hostoffer RW. Common variable immunodeficiency associated with birdshot-like chorioretinopathy. Ann Allergy Asthma Immunol 2014; 112:472-4. [PMID: 24631184 DOI: 10.1016/j.anai.2014.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/28/2013] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Joyce Oh
- University Hospitals, Cleveland, Ohio.
| | - Amy L Marks
- Children's Hospitals of Michigan Wayne State School of Medicine, Detroit, Michigan
| | | | - Haig Tcheurekdjian
- University Hospitals, Cleveland, Ohio; Allergy/Immunology Associates, Cleveland, Ohio
| | | | - Lawrence J Singerman
- University Hospitals, Cleveland, Ohio; Retina Associates of Cleveland, Inc., Cleveland, Ohio
| | - Robert W Hostoffer
- University Hospitals, Cleveland, Ohio; Allergy/Immunology Associates, Cleveland, Ohio
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Ocular Involvement in Primary Immunodeficiency Diseases. J Clin Immunol 2013; 34:23-38. [DOI: 10.1007/s10875-013-9974-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/20/2013] [Indexed: 12/18/2022]
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Orbital follicular hyperplasia in common variable immune deficiency syndrome. Ophthalmic Plast Reconstr Surg 2013; 29:e160-2. [PMID: 23446300 DOI: 10.1097/iop.0b013e3182873c61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Common variable immune deficiency (CVID) is characterized by reduced serum immune globulins and impaired or absent antibody responses. Patients become more susceptible to infections and to lymphoproliferation and granulomatous inflammation. Ophthalmic manifestations of CVID are rare. The authors describe a case of orbital follicular hyperplasia in a 15-year-old girl with CVID syndrome causing proptosis and exposure keratopathy.
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Granulomatous Disease in CVID: Retrospective Analysis of Clinical Characteristics and Treatment Efficacy in a Cohort of 59 Patients. J Clin Immunol 2012; 33:84-95. [DOI: 10.1007/s10875-012-9778-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
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Pasquet F, Kodjikian L, Mura F, Riviere S, Harroche J, Blanc AP, Chaix F, Oksenhendler E, Seve P. Uveitis and Common Variable Immunodeficiency: Data from the DEF-I Study And Literature Review. Ocul Immunol Inflamm 2012; 20:163-70. [DOI: 10.3109/09273948.2012.674612] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Maeyer V, Leroy BP, Kerre T, Ferdinande L, Haerynck F, De Baets F, Kestelyn P. Birdshot-like chorioretinopathy in common variable immunodeficiency. Retin Cases Brief Rep 2012; 6:358-364. [PMID: 25389930 DOI: 10.1097/icb.0b013e31824f71c8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To describe a patient with ocular manifestations secondary to common variable immunodeficiency. METHODS A 17-year-old adolescent girl presented with asymptomatic bilateral optic disk edema and chorioretinal infiltrates. These findings were noted during routine follow-up visits for hydroxychloroquine use for lymphoid interstitial pneumonia. She underwent a full ophthalmologic and systemic work-up. RESULTS At the age of 13, the patient was diagnosed with common variable immunodeficiency with splenomegaly, lymphadenopathy, and lymphoid interstitial pneumonia. Progressive generalized lymphadenopathy developed thereafter. Since the diagnosis of common variable immunodeficiency, she received monthly intravenous immunoglobulin, systemic corticosteroids and later on, oral hydroxychloroquine. Annual routine screening visits to exclude retinal hydroxychloroquine toxicity were unremarkable until age 17. Unaided visual acuity was 6/5 in both eyes. Slit-lamp examination was normal, whereas fundoscopy revealed bilateral optic disk edema and birdshot-like chorioretinal infiltrates, without signs of vitritis. A bilateral hot disk was seen on fluorescein angiography, but there were no signs of vasculitis. Indocyanine green angiography showed macular and midperipheral choroidal granulomas. A brain magnetic resonance imaging scan revealed no signs of raised intracranial pressure. Human leukocyte antigen-typing was negative for HLA-A29, making birdshot chorioretinopathy highly unlikely. The results of a work-up for sarcoidosis were not typical of that disease. During the past months, a remarkable episode of lacrimal gland swelling with spontaneous recovery was noted. CONCLUSION We describe a case of ocular manifestations of common variable immunodeficiency, including asymptomatic bilateral chorioretinal granulomas mimicking birdshot chorioretinopathy, combined with optic nerve sheath infiltration, and lacrimal gland involvement.
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Affiliation(s)
- Véronique de Maeyer
- *Department of Ophthalmology †Center for Medical Genetics ‡Department of Hematology §Department of Pathology ¶Department of Pediatrics, Unit of Pediatric Pneumology, Ghent University Hospital, Ghent, Belgium
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Oltra EZ, Morris C, Birnbaum AD, Tessler HH, Goldstein DA. Chronic Anterior Uveitis in Common Variable Immunodeficiency. Ocul Immunol Inflamm 2011; 19:448-9. [DOI: 10.3109/09273948.2011.625136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van der Vaart R, Greven C, Manning R, Haines N, Kurup SK. Unilateral solitary choroidal granuloma as presenting sign of secondary syphilis. Graefes Arch Clin Exp Ophthalmol 2011; 249:1575-7. [PMID: 21562892 DOI: 10.1007/s00417-011-1661-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/21/2010] [Accepted: 12/29/2010] [Indexed: 11/28/2022] Open
Affiliation(s)
- Robert van der Vaart
- Department of Ophthalmology, Wake Forest University Eye Center, Winston-Salem, NC 27157, USA
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Sarcoid-like granulomas in common variable immunodeficiency. Rheumatol Int 2009; 30:109-12. [DOI: 10.1007/s00296-009-0897-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 03/10/2009] [Indexed: 11/26/2022]
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McCannel CA, Pulido JS. Diffuse Placoid Choroidopathy in a Patient with Common Variable Immunodeficiency. Int Arch Allergy Immunol 2008; 147:84-6. [DOI: 10.1159/000129715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 01/24/2008] [Indexed: 11/19/2022] Open
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Malphettes M, Oksenhendler E, Galicier L, Fieschi C. [Granulomatous disease in common variable immunodeficiency]. Rev Med Interne 2007; 29:28-32. [PMID: 18054123 DOI: 10.1016/j.revmed.2007.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 10/02/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE Common variable immunodeficiency (CVID), defined by defective production of immunoglobulins, is the most common primary immunodeficiency in adulthood requiring a medical follow-up. Repeated bacterial infections and/or autoimmune manifestations and/or benign lymphoproliferation (including follicular hyperplasia and/or granulomatous disease) are the hallmark of the disease. This review aims at describing recent advances in the understanding and treatment of granulomatous disease in CVID. CURRENT KNOWLEDGE AND KEY POINTS Clinical features of granulomatous disease in CVID can mimic sarcoidosis, remarkable by the low levels of circulating immunoglobulins. Granulomas may be found in several organs in a single patient, and the main features are pulmonary, lymphoid, cutaneous, hepatic or splenic. The features of CVID is remarkable by the high frequency of autoimmune diseases complicating the immunodeficiency. Some immunological abnormalities have been described in such patients, including lymphopenia, decreased T-cells proliferations to mitogens and antigens. Rare polymorphisms in the gene encoding TNFalpha (Tumor Necrosis Factor) have been identified in CVID patients with granulomatous disease. FUTURE PROSPECTS AND PROJECTS The evolution of the disease is severe, particularly when the lung is involved. Treatment consists in immunoglobulins substitution, immunosuppressive agents (corticosteroids, cyclophosphamide) and anti-TNFalpha antibodies. These treatments are difficult to manage in such immunocompromised patients.
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Affiliation(s)
- M Malphettes
- Département d'immunologie clinique, hôpital Saint-Louis, 1 avenue Claude-Vellefaux, Paris, France
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Bibliography. Current world literature. Neuro-ophthalmology. Curr Opin Ophthalmol 2006; 17:574-5. [PMID: 17065928 DOI: 10.1097/icu.0b013e32801121a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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