Granulomatous Uveitis and Conjunctivitis Due to Common Variable Immune Deficiency: A Case Report

Area of Science:

• Ophthalmology
• Immunology
• Pathology

Background:

• Common variable immune deficiency (CVID) is a primary immunodeficiency characterized by hypogammaglobulinemia and impaired B-cell differentiation.
• Ocular manifestations in CVID are uncommon but can include infections and inflammatory conditions.
• Granulomatous inflammation is a specific pattern of immune response observed in various systemic and localized conditions.

Observation:

• A 72-year-old female with a history of CVID, managed with regular intravenous immunoglobulin (IVIG) infusions, presented with chronic conjunctivitis and granulomatous anterior uveitis.
• Ophthalmic examination revealed signs consistent with inflammation in the anterior segment of the eye.
• Conjunctival biopsy confirmed the presence of micro-granulomas within the conjunctival stroma and epithelium.

Findings:

• The patient's ocular symptoms responded to topical corticosteroid therapy but recurred upon discontinuation, indicating a steroid-dependent inflammatory process.
• Histopathological examination of the conjunctiva revealed chronic granulomatous inflammation, supporting the diagnosis of granulomatous conjunctivitis.
• The underlying CVID was considered a potential contributing factor to the development of these rare ocular inflammatory conditions.

Implications:

• This case highlights the importance of considering CVID in the differential diagnosis of patients presenting with recurrent or chronic conjunctivitis and uveitis of unknown etiology, particularly those with a history suggestive of immune dysfunction.
• Continued IVIG therapy is crucial for managing the systemic immune deficiency and may play a role in controlling ocular inflammation.
• Sustained topical steroid treatment is often necessary for managing the ocular inflammation, with careful monitoring for side effects.