Cutaneous granulomas in common variable immunodeficiency: case report and review of literature

Common variable immunodeficiency (CVID) is a heterogeneous disease characterized by recurrent infections, autoimmunity, malignancies, and granulomatous inflammation. Granulomatous lesion is one of the important manifestations of CVID, which continues to be unknown to many clinicians. While noncaseating granulomatous lesions can be detected in lungs, liver, spleen or conjunctiva of CVID patients, there are only few reported cases with skin granuloma. This report presents a 27-year-old female with multiple persistent cutaneous granulomatous lesions on both hands. The patient had been well until age of 20 years, when she developed these skin lesions and frequent upper respiratory infections and bacterial pneumonia. Also, she experienced recurrent diarrhea (more than 10 episodes). Laboratory evaluation showed decreased serum levels of all immunoglobulin isotypes and low specific antibody responses. The diagnosis of CVID was based on clinical and laboratory findings. Intravenous immunoglobulin therapy at a dosage of 400-500 mg/kg monthly was introduced and improved skin lesions. In conclusion, taking history of recurrent infections and measuring immunoglobulin levels can be suggested in patients with granulomatous lesions instead of other expensive tests.