Non-sarcoidal, non-tuberculoid granuloma in common variable immunodeficiency

Area of Science:

• Dermatology
• Immunology
• Pathology

Background:

• Common variable immunodeficiency (CVID) typically presents with sarcoidal or tuberculoid granulomas.
• This report focuses on an atypical presentation of CVID with non-sarcoidal, non-tuberculoid granulomas.

Observation:

• A 29-year-old male with CVID exhibited a vitiliginous patch, recurrent warts, chronic diarrhea, recurrent infections, subcutaneous nodules, and rheumatoid-like arthritis.
• Histopathology of subcutaneous nodules revealed fibrinoid degeneration of collagen surrounded by histiocytes, consistent with granuloma annulare.

Findings:

• The patient had significantly reduced serum immunoglobulins (IgG, IgA, IgM) and deficient T cell function.
• While infections and warts responded to immunoglobulin therapy, and vitiligo to PUVA, the subcutaneous nodules persisted.

Implications:

• This case expands the spectrum of cutaneous manifestations in CVID, presenting granuloma annulare as a rare possibility.
• It underscores the importance of considering diverse dermatological presentations in immunodeficient patients.