[Infection due to Mycobacterium bovis in common variable immunodeficiency]

Area of Science:

• Immunology
• Infectious Diseases
• Oncology

Context:

• Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by impaired antibody production, leading to recurrent infections.
• While CVID typically presents with bacterial infections, opportunistic infections and malignancies are also observed, though less commonly.
• The case involves a patient with CVID who developed severe disseminated Mycobacterium bovis infection and subsequently Hodgkin's lymphoma.

Purpose:

• To report an unusual case of disseminated Mycobacterium bovis infection in a patient diagnosed with Common Variable Immunodeficiency (CVID).
• To illustrate the susceptibility to opportunistic infections, specifically mycobacterial disease, in CVID patients.
• To highlight the co-occurrence of CVID, mycobacterial infection, and Hodgkin's lymphoma, emphasizing the complex interplay of immune defects and oncogenesis.

Summary:

• A 38-year-old female with CVID presented with weight loss, fatigue, and abdominal pain, later diagnosed with disseminated Mycobacterium bovis infection.
• The patient experienced complications including mesenteric lymphadenopathy, nosocomial pneumonia, renal abscess, and ultimately developed mixed cellularity Hodgkin's lymphoma.
• Treatment involved IVIG replacement, chemotherapy, and management of severe infections, underscoring the broad spectrum of CVID manifestations and associated risks.

Impact:

• This case emphasizes the potential for severe opportunistic infections, such as M. bovis, in CVID patients, indicating cellular immune susceptibility beyond humoral defects.
• It highlights the increased risk of malignancies, like Hodgkin's lymphoma, in individuals with CVID.
• The report contributes to understanding the multifaceted clinical challenges and management strategies for patients with CVID and co-existing complex infections and cancers.