Hypercalcemia in a patient with common variable immunodeficiency and renal granulomas

Area of Science:

• Immunology
• Nephrology
• Endocrinology

Background:

• Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency, characterized by low immunoglobulin levels and impaired B-cell function.
• While granulomatous inflammation is a recognized manifestation of CVID, renal involvement is exceptionally rare.
• Differentiating granulomatous CVID from other granulomatous diseases like sarcoidosis can be clinically challenging.

Observation:

• This report describes the first documented case of CVID presenting with biopsy-proven noncaseating renal granulomas.
• The patient also exhibited hypercalcemia, a metabolic abnormality not typically associated with CVID.
• The renal biopsy confirmed the presence of granulomatous inflammation within the kidney tissue.

Findings:

• The study highlights a rare association between CVID, noncaseating renal granulomas, and hypercalcemia.
• It suggests that granulomatous inflammation in the kidneys can be a manifestation of CVID.
• The findings underscore the complex and varied clinical presentations of CVID.

Implications:

• This case expands the known spectrum of CVID manifestations, particularly renal involvement.
• Understanding the mechanism of hypercalcemia in granulomatous disorders is crucial for patient management.
• The case emphasizes the importance of considering CVID in the differential diagnosis of granulomatous kidney disease, especially when hypercalcemia is present.