Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

A Mystery Case of Abdominal Masses

Vania Lin, MD, MPH, Robert Odrobina, MD, Maria A. Pletneva, MD, PhD, & Dorota Lebiedz-Odrobina, MD, RhMSUS  |  Issue: May 2021  |  May 13, 2021

Conclusion

The uncommon presentation of granulomatous disease among CVID patients, as well as the consideration of alternative or overlapping infectious, autoimmune or malignant etiologies, poses a diagnostic and treatment challenge. Given the potential for poor outcomes—including infection, unnecessary procedures and progression of disease—with delayed recognition, misdiagnosis or inappropriate treatment, consideration of an immunodeficiency disease is of high importance when approaching a patient with granulomatous disease.


Vania Lin, MD, MPHVania Lin, MD, MPH, is an internal medicine resident at the University of Nevada, Reno, School of Medicine. She plans to pursue a fellowship in rheumatology.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Dr. OdrobinaRobert Odrobina, MD, is an assistant professor in the Division of Infectious Diseases at the University of Utah, Salt Lake City. His main clinical interests include infections in immunocompromised hosts, especially after bone marrow and solid organ transplantation.

DR. PletnevaMaria A. Pletneva, MD, PhD, is a gastrointestinal pathologist in the Department of Pathology at the University of Utah.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Dorota Lebiedz-Odrobina, MD, RhMSUSDorota Lebiedz-Odrobina, MD, RhMSUS, is an assistant professor in the Department of Medicine and rheumatology fellowship program director at the University of Utah.

References

  1. Tam JS, Routes JM. Common variable immunodeficiency. Am J Rhinol Allergy. 2013 Jul-Aug;27(4):260–265.
  2. Ardeniz O, Cunningham-Rundles C. Granulomatous disease in common variable immunodeficiency. Clin Immunol. 2009 Nov;133(2):198–207.
  3. Hatab AZ, Ballas ZK. Caseating granulomatous disease in common variable immunodeficiency treated with infliximab. J Allergy Clin Immunol. 2005 Nov;116(5):1161–1162.
  4. Pierson JC, Camisa C, Lawlor KB, et al. Cutaneous and visceral granulomas in common variable immunodeficiency. Cutis. 1993 Oct;52(4):221–222.
  5. Plana Pla A, Bassas-Vila J, Roure S, et al. Necrotizing and sarcoidal granulomas in the skin and synovial membrane, associated with common variable immunodeficiency. Clin Exp Dermatol. 2015 Jun;40(4):379–382.
  6. Torrelo A, Mediero IG, Zambrano A. Caseating cutaneous granulomas in a child with common variable immunodeficiency. Pediatr Dermatol. 1995 Jun;12(2):170–173.
  7. Wang J, Rodriguez-Davalos M, Levi G, et al. Common variable immunodeficiency presenting with a large abdominal mass. J Allergy Clin Immunol. 2005 Jun;115(6):1318–1320.
  8. Mechanic LJ, Dikman S, Cunningham-Rundles C. Granulomatous disease in common variable immunodeficiency. Ann Intern Med. 1997 Oct;127(8 Pt 1):613–617.
  9. Zumla A, James DG. Granulomatous infections: Etiology and classification. Clin Infect Dis. 1996 Jul;23(1):146–158.
  10. James DG. A clinicopathological classification of granulomatous disorders. Postgrad Med J. 2000 Aug;76(898):457–465.
  11. Ungprasert P, Ryu JH, Matteson EL. Clinical manifestations, diagnosis, and treatment of sarcoidosis. Mayo Clin Proc Innov Qual Outcomes. 2019 Aug 2;3(3):358–375.
  12. Heinle R, Chang C. Diagnostic criteria for sarcoidosis. Autoimmun Rev. 2014 Apr–May;13(4–5):383–387.
  13. Rao N, Mackinnon AC, Routes JM. Granulomatous and lymphocytic interstitial lung disease: A spectrum of pulmonary histopathologic lesions in common variable immunodeficiency–histologic and immunohistochemical analyses of 16 cases. Hum Pathol. 2015 Sep;46(9):1306–1314.
  14. Shah KK, Pritt BS, Alexander MP. Histopathologic review of granulomatous inflammation. J Clin Tuberc Mycobact Dis. 2017 Feb 10;7:1–12.
  15. Park JH, Levinson AI. Granulomatous-lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CVID). Clin Immunol. 2010 Feb;134(2):97–103.
  16. Chase NM, Verbsky JW, Hintermeyer MK, et al. Use of combination chemotherapy for treatment of granulomatous and lymphocytic interstitial lung disease (GLILD) in patients with common variable immunodeficiency (CVID). J Clin Immunol. 2013 Jan;33(1):30–39.
  17. Boursiquot J-N, Gérard L, Malphettes M, et al. Granulomatous disease in CVID: Retrospective analysis of clinical characteristics and treatment efficacy in a cohort of 59 patients. J Clin Immunol. 2013 Jan;33(1):84–95.

Page: 1 2 3 4 | Single Page
Share: 

Filed under:Conditions Tagged with:case reportCommon variable immunodeficiencyGranulomatosis

Related Articles

    Common Variable Immunodeficiency

    June 1, 2008

    Genetic insights into a complex and baffling disease

    When Immunodeficiency & Autoimmunity Coexist

    January 17, 2019

    CHICAGO—Although rare, when a patient has both primary immune deficiency and autoimmune disease, the combination can lead to life-threatening complications requiring careful, long-term therapy. In When Immune Deficiency and Autoimmunity Coexist, a session at the 2018 ACR/ARHP Annual Meeting, M. Eric Gershwin, MD, the Jack and Donald Chia professor of Medicine and chief of Rheumatology,…

    When Immunodeficiency & Autoimmunity Coexist

    December 18, 2018

    When a patient has both primary immune deficiency and autoimmune disease, the combination can lead to life-threatening complications. Here are some insights into the challenges of diagnosing and treating this rare subset of patients…

    The Mystery of IVIg

    March 8, 2012

    Although initially given as replacement therapy for patients with primary and secondary immunodeficiency states, intravenous immunoglobulin (IVIg) has proven to be effective in the treatment of various autoimmune and inflammatory disorders. This success has led to a dramatic increase in the use of IVIg, with its use as an antiinflammatory agent now vastly surpassing its use in the treatment of immunodeficiencies. Even so, the basis for the antiinflammatory activity of IVIg remains unclear.

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences