Inflammatory Arthritis in a Patient with Common Variable Immunodeficiency (CVID)

Introduction

CVID is the most common primary immunodeficiency in adults. It is defined as poor response to vaccines and low immunoglobulins, excluding other causes. Paradoxically, one of the most common complications of CVID is autoimmunity involving many systems. However, these usually resolve or improve with immunoglobulin injection. Here, we present a rare case of a patient with inflammatory arthritis that progressively worsened despite treatments.

Method

Case report with literature review

Result

A 55-year-old male with history of hypothyroidism, granuloma annulare, common variable immunodeficiency, and osteoporosis presented with arthralgia. The pain and swelling involved most of the hand joints, bilateral wrists, elbows, and knees. He has been receiving weekly subcutaneous immunoglobulin G without complications. The treatment regimen involved hydroxychloroquine, methotrexate that was replaced with leflunomide, and chronic use of low-dose oral prednisone that led to osteoporosis. Physical exam revealed mild synovitis and tenderness at all joints of the hand and wrists. Autoimmune markers are all negative except for positive ANA. Recent hand radiogram showed mild erosion of the right fifth proximal phalanx. The patient did not show improvement with the regimen, and discussion would be made with immunologists and rheumatologists to consider additional treatments.

Discussion

Autoimmunity in CVID can involve inflammatory arthritis symptoms mostly resolved with immunoglobulin injection and treatment regimen. The case report showed a rare scenario and emphasized the unpredictable response to standard arthritis treatments. More clinical trials on the effect of medication on CVID complications are needed, and these patients require more careful monitoring with multiple specialty professionals.