Association of Secondary Amyloidosis With Common Variable Immune Deficiency and Tuberculosis diarrhea with 3-4 bowel movements/day devel- oped, and repeated diagnostic tests revealed no specific cause. Metronidazole was recommended for 3 further months during which the patient's diarrhea disappeared and he put on 18 kg but hypogammaglobulinemia and nephrotic-range proteinuria persisted. Later, colchicine 1.5 mg/day was administered to hopefully control proteinuria. At the end of the third year of follow-up; the patient was still using colchicine and also metro- nidazole (500 mg, bid, p.o.) for one week every month or in the case of > 3 mushy stools/day lasting > 3 days. The control gastroscopy and rec- tosigmoidoscopy were normal: biopsies showed AA amyloid infiltration. Although the patient had hypogammaglobulinemia, his condition did not worsen except for recurrent upper respiratory tract infections, a recent acute attack of chronic otitis media, and chronic recurrent diarrhea. The patient's creatinine clearance was normal, but the proteinuria was still in the nephrotic range. DISCUSSION Pulmonary tuberculosis in patients with CVID was reported as a rare entity in the literature.7 Whether this concurrent disease pairing is just coincidence or due to a defect in T-cell function is not clear. Because of the high prevalence of tuberculosis (0.38%) in the general population in Turkey (Data from the Ministry of Health, 1992), we cannot exclude the possibility of coincidence. T-cell dysfunction may be present in up to half of CVID cases.3,8 In this case, although the presence of tuberculosis might still have been related to a T-cell functional defect which accompanies CVID, normal lymphocyte function tests and a positive tuberculin skin test, suggest no T-cell dysfunction. Although recurrent infections are common in CVID,3,7-9 no other reported case of secondary amyloidosis accompanying CVID, could be found. Renal amyloidosis secondary to pulmonary tuber- culosis is fairly common (3.6-50%).10,11 In this case, it is difficult to determine the duration of the subclinical pulmonary tuberculosis. However, the development of cavitation suggests that the patient has had a long period of silent inflamma- tion which may have been a reason for secondary amyloidosis. Therefore, although tuberculosis may not be the only possible cause of amyloidosis in this case, it is easy to comment on whether other frequent infections had some additive effect on the inflammatory response. In Turkey, one of the possible causes of amyloidosis might have been FMF, but in our patient there was no history suggestive of FMF and none of the described FMF gene mutations were present. In this case, one possible cause for recurrent diarrhea may have been intestinal tuberculosis. Although intestinal tuberculosis accompanies cavitary tuberculosis and positive sputum smears, with a much higher incidence than in noncavitary tuberculosis,12 worsening of the diarrhea since the patient's childhood in a continuous fashion 2 months after cessation of antituberculosis therapy, might prove that tuberculosis was probably not the cause of the diarrhea. Also, there were no signs suggestive of intestinal tuberculosis, both radiologically and endoscopically. Furthermore, Mycobacterium tuberculosis could not be seen in direct examination of, and specific cultures of, the stool. There is an increased incidence of Crohn's dis- ease in CVID13 and this may have been another cause for this patient's diarrhea. As in intestinal tuberculosis, amyloidosis secondary to Crohn's disease is also rare in the literature.14,15 In this case, increased mucosal thickness of the valvula conniventes, visible with a barium meal, were suggestive of Crohn's disease. However, gastro- intestinal system biopsies did not reveal any histologic findings supporting granulomatous bowel disease. Viral etiologies for diarrhea were excluded by negative serology and by the absence of inclusion bodies in the biopsy specimens. . Also, colchicine, which was used in this patient, could possibly cause mild diarrhea. Colchicine was shown to have promising results in experimental cases of secondary amyloidosis but it is not that effective clinically.16 In this patient however, it was intro- duced after the onset of diarrhea. In the case of gastrointestinal amyloidosis, de- creased gastrointestinal motility causes bacterial overgrowth, bile acid deconjugation and conse- quently, diarrhea, steatorrhea and severe malab- sorption.17 In this case, another possible cause of Yonsei Med J Vol. 46, No. 6, 2005