Yonsei Medical Journal Vol. 46, No. 6, pp. 847 - 850, 2005 Association of Secondary Amyloidosis with Common Variable Immune Deficiency and Tuberculosis Aykut Ferhat Çelık,1 Mehmet Riza Altiparmak,2 Gülsüm Emel Pamuk,3 Ömer Nurı Pamuk,4 and Fehmı Tabak5 Departments of 1Gastroenterology, 2Nephrology, 5Clinical Bacteriology and Infectious Diseases, Cerrahpaşa Medical Faculty, University of İstanbul, İstanbul, Turkey; Departments of 3Hematology and 4Rheumatology, Trakya Medical Faculty, University of Trakya, Edirne, Turkey. This paper describes the first case of common variable immunodeficiency (CVID) and AA amyloidosis. A recently treated tuberculosis, and chronic inflammation induced by frequent respiratory tract infections, were thought to be respon- sible for the amyloidosis. No other reason for this condition could be detected. Although T cell dysfunction in some CVID patients has been reported, pulmonary tuberculosis is quite rare with this condition. Bacterial or viral agents or evidence in favour of intestinal tuberculosis, which would explain this patient's recurrent diarrhea, were not found. In this case, the response of the attacks of diarrhea to metranidazole and the histologic observation of extensive intestinal amyloid deposi- tion, which is known to decrease intestinal motility, made us conclude that the diarrhea was associated with bacterial overgrowth. In this report, we discuss the association of CVID and tuberculosis to secondary amyloidosis and recurrent diarrhea. Key Words: Common variable immunodeficiency, secondary amyloidosis, tuberculosis, diarrhea INTRODUCTION Common variable immunodeficiency (CVID) is a not uncommon disease which usually manifests in the second or third decade of life with recurrent bacterial infections and hypoglobulinemia.1,2 There is surprisingly, a high incidence of gastroin- Received February 27, 2003 Accepted November 4, 2003 Reprint address: requests to Dr. Mehmet Rıza Altıparmak, Departments of Nephrology, Cerrahpaşa Medical Faculty, Uni- versity of İstanbul, Rasimpaşa Mah, Taşlıbayır Sok, No: 14 Daire: 10, Kadıkoy-İstanbul, Turkey. Tel: 90-216-348-4923, Fax: 90-212- 5743186, E-mail: gepamuk@yahoo.com testinal diseases and chronic diarrhea, which is reported in as many as 30% of these patients. A microbial agent can be identified in fewer than half the cases and is most likely to be Giardia lamblia or bacterial overgrowth in the small bowel.3 Enteroviral infections may occur but they are not a major problem. Chronic diarrhea is one of the most common presentations of the disease and it can sometimes be quite troublesome. Although the diarrhea is usually infectious, it may be associated with Crohn's disease, gluten entero- pathy, collagenous colitis, achlorhydria and pernicious anemia.4-6 Recurrent bacterial infections during the course of CVID have been reported; however, the devel- opment of tuberculosis and secondary amyloi- dosis has not been reported until now. In this current case, the first patient in the literature with CVID and amyloidosis, who presented with recently worsened chronic diarrhea and sepsis, is described. A rare case of tuberculosis with CVID and their amyloid relationship is discussed. CASE REPORT A 28-year-old male was admitted to our hospi- tal with a-two-month history of diarrhea, abdomi- nal pain, weight loss, fever, and fatigue. His medi- cal history revealed 3 to 5 episodes of diarrhea each year and recurrent respiratory tract infec- tions since the age of 14 years old. He had been succesfully treated for postprimary cavitary pul- monary tuberculosis (acid-fast bacteria in smears Yonsei Med J Vol. 46, No. 6, 2005