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Related Experiment Videos

Granulomas in common variable immunodeficiency: a diagnostic dilemma.

Karyn R Lun1, Dominic J Wood, James B Muir

  • 1South-East Dermatology, Carina Heights and IQ Pathology, West End, Queensland, Australia.

The Australasian Journal of Dermatology
|February 14, 2004
PubMed
Summary

A patient with common variable immunodeficiency developed sarcoid-like granulomas. A single acid-fast bacillus was found, but later deemed a contaminant, and lesions responded to steroids and tetracycline.

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Area of Science:

  • Immunology
  • Dermatology
  • Infectious Diseases

Background:

  • Common variable immunodeficiency (CVID) predisposes individuals to various infections and autoimmune phenomena.
  • Granulomatous inflammation, including sarcoidosis, can occur in CVID patients, posing diagnostic challenges.
  • Distinguishing true infections from inflammatory conditions is crucial for appropriate management.

Observation:

  • A 60-year-old male with CVID presented with a 7-year history of violaceous plaques and papules.
  • New lesions on the hands showed necrotizing granulomas with a single acid-fast bacillus (AFB) on initial biopsy.
  • Subsequent investigations failed to confirm mycobacterial infection, suggesting the AFB was a contaminant.

Findings:

  • The patient's lesions were diagnosed as sarcoid-like granulomas, not true sarcoidosis.

Related Experiment Videos

  • Intralesional triamcinolone acetonide and oral tetracycline led to a good clinical response.
  • The presence of a single AFB on histology in CVID patients with granulomatous inflammation requires careful interpretation.

    • Implications:

    • This case highlights the diagnostic complexities of granulomatous skin lesions in immunocompromised patients.
    • Tetracycline therapy may be beneficial for sarcoid-like granulomas, even in the absence of confirmed bacterial infection.
    • The significance of incidental findings like a single AFB in histology needs thorough evaluation to avoid misdiagnosis and inappropriate treatment.