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Kronik ishalden, immün yetmezlik tanısına: İntestinal noduler lenfoid hiperplazinin eşlik ettiği bir common variable immün yetmezlik olgusu

Year 2005, Volume: 4 Issue: 3, 193 - 196, 01.12.2005

Abstract

On yedi yaşında bayan bir hasta kronik ishal nedeniyle yatırıldı. Çocukluğundan beri tekrarlayan solunum yolları enfeksiyonları ve ishal atakları tanımlamaktaydı. Endoskopik bakıda düodenum mukozasında yaygın kümeleşmiş polipoid noduller vardı. Biyopsi örneği noduler lenfoid hiperplaziyi göstermekteydi. Common variable immün yetmezlik sendromundan şüphelenildi ve tanı, plazma gama-globulin düzeylerinin düşüklüğünün gösterilmesiyle doğrulandı. İmmünglobulin tedavisinin başlanması ndan sonra günlük ishal sayısı ve solunum yolları enfeksiyonlarının sıklığı ve şiddeti belirgin azaldı. Bu olgu ishalin altta yatan bir nedeni olarak Common variable immün yetmezlik sendromuna ve noduler lenfoid hiperplazi ile olan ilişkisine odaklanmaktadır.

References

  • Spickett GP, Misbah SA, Chapel HM. Primary antibody deÆciency in adults. Lancet 1991; 337: 281-4.
  • Luzi G, Zullo A, Iebba F, Rinaldi V, et al. Duodenal pathology and clinical-immunological implications in common variable immuno- deficiency patients. Am J Gastroenterol. 2003; 98(1): 118-21.
  • Bastlein C, Burlefinger R, Holzberg E, et al. Common variable im- munodeficiency syndrome and nodular lymphoid hyperplasia in the small intestine. Endoscopy. 1988; 20(5): 272-5.
  • Riddell RH, Petras RE, Williams GT, et al. Lymphoprolipherative disorders of the intestines. In: Riddell RH, Petras RE, Williams GT, Sobin LH, eds. Tumors of the intestines. Washington, DC: Armed Forces Institue of Pathology; 2003: 395-430. Atlas of tumor patho- logy; 3rdseries, fascicle 32.
  • Aguilar FP, Alfonso V, Rivas S, et al. Jejunal malignant lymphoma in a patient with adult-onset hypo-gamma-globulinemia and nodu- lar lymphoid hyperplasia of the small bowel. Am J Gastroenterol. 1987; 82(5): 472-5.
  • Matuchansky C, Touchard G, Lemaire M, et al. Malignant lympho- ma of the small bowel associated with diffuse nodular lymphoid hyperplasia. N Engl J Med. 1985 18; 313(3): 166-71.
  • Iglesias Alzueta J, Matamoros Flori N. Common variable immuno- deficiency. Allergol Immunopathol (Madr). 2001 May-Jun; 29(3): 113-8.
  • Isgro A, Marziali M, Mezzaroma I, Luzi G, et al. Bone marrow clo- nogenic capability, cytokine production, and thymic output in pati- ents with common variable immunodeficiency. J Immunol. 2005 15; 174(8): 5074-81.
  • Bloch-Michel C, Viallard JF, Blanco P, Liferman F, Neau D, et al. Common variable immunodeficiency: 17 observations in the adult Rev Med Interne. 2003; 24(10): 640-50.
  • Sanchez Rodriguez A, Martinez JM, de Letona L, et al. Nodular lymphoid hyperplasia of the small bowel with IgA deficiency and he- molytic anemia Med Clin (Barc). 1980 10; 75(6): 261-5.
  • Van der Hilst JC, Smits BW, van der Meer JW. Hypogammaglobu- linaemia: cumulative experience in 49 patients in a tertiary care ins- titution. Neth J Med. 2002; 60(3): 140-7.
  • Aukrust P, Muller F, Ueland T, et al. Decreased vitamin A levels in common variable immunodeficiency: vitamin A supplementation in vivo enhances immunoglobulin production and downregulates inf- lammatory responses. Eur J Clin Invest. 2000; 30(3): 252-9.

From chronic diarrhoea to diagnosis of immundeficiency: A case with common variable immunodeficiency accompanied by intestinal nodular lymphoid hyperplasia

Year 2005, Volume: 4 Issue: 3, 193 - 196, 01.12.2005

Abstract

A 17-year-old female patient was hospitalized for chronic diarrhea. Since childhood she had experienced recurrent episodes of respiratory tract infections and diarrhea. Endoscopic examination revealed diffuse clustered polypoid nodules in the duodenum. Biopsy specimen showed nodular lymphoid hyperplasia. Common variable immunodeficiency syndrome was suspected and diagnosis was established by demonstrating a significant reduction of plasma gamma-globulin levels. After starting immunoglobulin treatment, daily diarrhea count decreased, and both incidence and severity of respiratory tract infections were significantly reduced. This case report focuses on common variable immunodeficiency syndrome as a potential underlying cause of diarrhea, and the relationship with nodular lymphoid hyperplasia.

References

  • Spickett GP, Misbah SA, Chapel HM. Primary antibody deÆciency in adults. Lancet 1991; 337: 281-4.
  • Luzi G, Zullo A, Iebba F, Rinaldi V, et al. Duodenal pathology and clinical-immunological implications in common variable immuno- deficiency patients. Am J Gastroenterol. 2003; 98(1): 118-21.
  • Bastlein C, Burlefinger R, Holzberg E, et al. Common variable im- munodeficiency syndrome and nodular lymphoid hyperplasia in the small intestine. Endoscopy. 1988; 20(5): 272-5.
  • Riddell RH, Petras RE, Williams GT, et al. Lymphoprolipherative disorders of the intestines. In: Riddell RH, Petras RE, Williams GT, Sobin LH, eds. Tumors of the intestines. Washington, DC: Armed Forces Institue of Pathology; 2003: 395-430. Atlas of tumor patho- logy; 3rdseries, fascicle 32.
  • Aguilar FP, Alfonso V, Rivas S, et al. Jejunal malignant lymphoma in a patient with adult-onset hypo-gamma-globulinemia and nodu- lar lymphoid hyperplasia of the small bowel. Am J Gastroenterol. 1987; 82(5): 472-5.
  • Matuchansky C, Touchard G, Lemaire M, et al. Malignant lympho- ma of the small bowel associated with diffuse nodular lymphoid hyperplasia. N Engl J Med. 1985 18; 313(3): 166-71.
  • Iglesias Alzueta J, Matamoros Flori N. Common variable immuno- deficiency. Allergol Immunopathol (Madr). 2001 May-Jun; 29(3): 113-8.
  • Isgro A, Marziali M, Mezzaroma I, Luzi G, et al. Bone marrow clo- nogenic capability, cytokine production, and thymic output in pati- ents with common variable immunodeficiency. J Immunol. 2005 15; 174(8): 5074-81.
  • Bloch-Michel C, Viallard JF, Blanco P, Liferman F, Neau D, et al. Common variable immunodeficiency: 17 observations in the adult Rev Med Interne. 2003; 24(10): 640-50.
  • Sanchez Rodriguez A, Martinez JM, de Letona L, et al. Nodular lymphoid hyperplasia of the small bowel with IgA deficiency and he- molytic anemia Med Clin (Barc). 1980 10; 75(6): 261-5.
  • Van der Hilst JC, Smits BW, van der Meer JW. Hypogammaglobu- linaemia: cumulative experience in 49 patients in a tertiary care ins- titution. Neth J Med. 2002; 60(3): 140-7.
  • Aukrust P, Muller F, Ueland T, et al. Decreased vitamin A levels in common variable immunodeficiency: vitamin A supplementation in vivo enhances immunoglobulin production and downregulates inf- lammatory responses. Eur J Clin Invest. 2000; 30(3): 252-9.
There are 12 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Şerif Yılmaz This is me

Kadim Bayan This is me

Mehmet Dursun This is me

Fikri Canoruç This is me

Publication Date December 1, 2005
Published in Issue Year 2005 Volume: 4 Issue: 3

Cite

APA Yılmaz, Ş., Bayan, K., Dursun, M., Canoruç, F. (2005). Kronik ishalden, immün yetmezlik tanısına: İntestinal noduler lenfoid hiperplazinin eşlik ettiği bir common variable immün yetmezlik olgusu. Akademik Gastroenteroloji Dergisi, 4(3), 193-196.

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