Answer to CC #15

Case Challenge # 15 presented a 42-year-old white female with recurrent pneumonia in the setting of chronic dyspnea x 15 years without a determined etiology. She also has a history of COPD without smoking and recurrent sinus infections since childhood. She also notes chronic loose stools with occasional constipation for 10 years. Her mother also had COPD and recurrent sinus infections. Exam reveals no clubbing or nasal polyps.  CT chest reveals bronchial wall thickening and dilatation predominantly in the lower lung fields consistent with bronchiectasis.

Which of the following is the best initial test to establish the diagnosis?

CC 15(results of voting)

The correct answer is measurement of immunoglobulin levels!

The patient has CVID (common variable immunodeficiency)

  • CVID is a heterogeneous disorder characterized by markedly reduced serum concentrations of IgG, low levels of IgA and/or IgM, and poor or absent responses to immunization.
  • The disorder affects males and females equally, and usually has a later age of onset than other antibody-deficiency disorders (i.e., > 10 years of age).
  • It is associated with recurrent sinopulmonary infections, autoimmune and granulomatous disease, gastrointestinal complications and an enhanced risk of malignancy (e.g., lymphoma and gastric carcinoma).
  • Some patients may also present with bronchiectasis (irreversible widening of portions of the bronchi resulting from damage to the airway wall), which is a common cause of morbidity and mortality in these patients.
  • Ig replacement therapy is the mainstay of therapy for antibody-deficiency disorder
  • Antibiotic and antifungal prophylaxis are also recommended for some to prevent the frequency and severity of infections.

Case challenge #16 (aka the Parkland Files!) will be posted next week!



Allergy, Asthma & Clinical Immunology 2011, 7(Suppl 1):S11 . Published under the terms of the Creative Commons Attribution License (



Grand Rounds Review: Chronic Back Pain

This morning, Dr. Una Makris, from the UT Southwestern Division of Rheumatology, gave an excellent talk on the diagnosis and management of chronic low back pain in older adults, a problem that costs more annually than most chronic medical conditions. In her talk, she noted that a multi-modal approach, with physical therapy, cognitive behavioral therapy, pain control, and a host of other methods to deal with this problem. Significant research in the area suggests that we are over-treating and over-spending, without a considerable impact on the burden of this often debilitating condition. In fact, a recent article in the JAMA notes that among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. For more information, check out the articles below: