FDG-Avid Granulomatous Lymphocytic Interstitial Lung Disease With Common Variable Immunodeficiency

Area of Science:

• Pulmonology
• Immunology
• Nuclear Medicine

Background:

• Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by impaired antibody production.
• Patients with CVID are at increased risk for various pulmonary complications and lymphoproliferative disorders.

Observation:

• A 26-year-old woman with CVID presented with interstitial pulmonary abnormalities and enlarged mediastinal/hilar lymph nodes.
• FDG PET/CT demonstrated increased FDG uptake in both ground-glass opacities and pulmonary nodules.
• Multiple lymph nodes (axillary, mediastinal, hilar, inguinal) also showed significant FDG avidity.

Findings:

• The imaging findings, combined with clinical presentation, led to the diagnosis of granulomatous-lymphocytic interstitial lung disease (GLILD).
• Cytology of mediastinal lymph nodes was non-specific for malignancy.
• Histology of an axillary lymph node revealed reactive changes without evidence of malignancy.

Implications:

• FDG PET/CT is a valuable tool for evaluating pulmonary and nodal abnormalities in CVID patients.
• Identifying GLILD is crucial for appropriate management and monitoring of CVID-associated lung disease.
• This case highlights the utility of integrated imaging and histopathological assessment in diagnosing complex conditions in immunocompromised individuals.