12 November 2013 : Case report
Pneumococcal meningitis in a young adult female with common variable immunodeficiency
Challenging differential diagnosis, Rare diseaseChad J. CooperABCDEF, Sarmad SaidDEF, Raphael QuansahDEF, Sayeed KhalillullahDEF, Ogechika AlozieDEF
Am J Case Rep 2013; 14:471-475
Background: Common variable immunodeficiency (CVID) is a primary immunodeficiency associated with hypogammaglobulinemia and other various clinical manifestations. It is a rare disease with a prevalence of CVID is approximately 1: 50,000–200,000. Clinical manifestations of CVID include recurrent bacterial infections, autoimmune, gastrointestinal, lymphoproliferative, granulomatous, and malignancy.
Case Report: Twenty-two year-old Hispanic female presented with a throbbing headache, nuchal rigidity, photophobia and a high grade fever. Lumbar puncture with CSF assessment revealed a turbid fluid with WBC of 6937 per uL, polymorphnuclear cells of 81%, protein 248 mg/dL, glucose <3 mg/Dl. CSF antigens were positive for Streptococcus pneumonia and CSF culture grew pansensitive Strepococcus pneumonia. Immunoglobin (Ig) levels of IgA, IgE, IgG and IgM were all decreased. Absolute cell counts of CD3, CD4 and CD8 were all low. Bone marrow biopsy was normocellular. Excisional lymph node biopsy revealed lymph nodes with reactive follicular hyperplasia. Common variable immunodeficiency disease (CVID) was diagnosed based on exclusion. IVIG therapy was given and patient received a two-week course of ceftriaxone.
Conclusions: The diagnosis of CVID is made based on the following criteria: 1) Marked decrease of IgG and at least one of the IgM or IgA isotypes. 2) The onset of immunodeficiency at greater than 2 years old. 3) Absence of isohemagglutinins and/or poor response to vaccines 4) Exclusion of other defined causes of hypogammaglobulinemia. A definite diagnosis is often late because it is wrongly assumed that primary immunodeficiencies are extremely rare, hence many patients are already seriously ill at the time of presentation.
Keywords: immunoproliferative, Immunodeficiency disorder, Streptococcus pneumoniae, bacterial meningitis, Common Variable Immunodeficiency
25 May 2023 : Case reportNeuroendocrine Carcinoma of the Extrahepatic Bile Ducts: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939239
24 May 2023 : Case reportAn Initially Missed Diagnosis of Venous Thromboembolic Phenomenon in Adult-Onset Still’s Disease: A Case Re...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939520
24 May 2023 : Case reportSuccessful Surgical Removal of a Giant Serous Ovarian Cyst in a 52-Year-Old Woman with Presurgical Body Mas...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939697
23 May 2023 : Case reportSuccessful Noninvasive Respiratory Management of an Infant with Bilateral Choanal Atresia and a Supernumera...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939642
Most Viewed Current Articles
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
07 Dec 2021 : Case reportEdwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Fac...
Am J Case Rep 2021; 22:e934347