Aykut Ferhat Çelık, et al. diarrhea is giardiasis frequently seen in CVID. The resolution of symptoms with oral metroni- dazole in each attack of diarrhea, suggests that either bacterial overgrowth or giardiasis were responsible for the diarrhea. However, giardia was not seen in stool analysis, duodenal biopsies or duodenal aspiration which suggests bacterial overgrowth. In addition, Whipple's disease can also present with the same symptomology and responds to broad-spectrum antibiotics but has frequent recurrence of symptoms. However, the intestinal biopsy specimens in our case did not reveal the presence of any PAS positive microoor- ganisms. In this case, extensive amyloid infiltration and incomplete local defences inducing overgrowth are the probable causes of diarrhea. It is unusual to see tuberculosis with CVID. However, the coin- cidence of this occurring, in a country endemic for tuberculosis, is not surprising. Secondary amyloi- dosis in this case was most probably due to the additive effects of tuberculosis and recurrent bac- terial infections during the course of CVID. REFERENCES 1. Sneller MC, Strober W, Eisenstein E, Jaffe JS, Cunningham-Rundles C. NIH conference. New insights into common variable immunodeficiency. Ann Intern Med 1993;118:720-30. 2. Hermans PE, Diaz-Buxo JA, Stobo JD. Idiopathic late onset immunoglobulin deficiency. Clinical observations in 50 patients. Am J Med 1976;61:221-32. 3. Cunningham-Rundles C. Clinical and immunologic analysis of 103 patients with common variable immu- nodeficiency. J Clin Immunol 1989;9:22-33. 4. Washington K, Stenzel TT, Buckley RH, Gottfried MR. Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglo- bulinemia. Am J Surg Pathol 1996;20:1240-52. 5. Byrne MF, Royston D, Patchett SE. Association of com- Yonsei Med J Vol. 46, No. 6, 2005 mon variable immunodeficiency with atypical collagen- ous colitis. Eur J Gastroenterol Hepatol 2003;15:1051-3. 6. Tanus T, Levinson AI, Atkins PC, Zweiman B. Polyau- toimmune syndrome in common variable immuno- deficiency. J Intern Med 1993;234:525-7. 7. Yocum MW, Kelso JM. Subspecialty clinics: Common variable immunodeficiency: the disorder and treatment. Mayo Clin Proc 1991;66:83-96. 8. Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol 1999;92:34-48. 9. Ament ME, Rubin CE. Relation of giardiasis to abnor- mal intestinal structure and function in gastrointestinal immunodeficiency syndromes. Gastroenterology 1972; 62:216-26. 10. Bely M, Apathy A. Disease modifying factors in chronic polyartritis. Correlations among systemic vasculitis, secondary amyloidosis, septic infections and occurrence of miliary epitheloid-cell granuloma. A review of autopsies. Zentralbl Pathol 1993;139:51-60. 11. Urban BA, Fishman EK, Goldman SM, Scott WW Jr, Jones B, Humphrey RL, et al. CT evaluation of am- yloidosis: spectrum of disease. Radiographics 1993;13: 1295-308. 12. Hamer DH, Gorbach SL. Infectious diarrhea and bacterial food poisoning. In: Feldman M, Scharsschmidt BF, Sleisenger MH, editors. Gastrointestinal and liver disease, 6 th ed. Philadelphia: W.B. Saunders Company; 1998. p.1594-632. 13. Kagnof MS. Immunology and inflammation of the gastrointestinal tract. In: Feldman M, Scharsschmidt BF, Sleisenger MH, editors. Gastrointestinal and liver dis- ease. Sixth ed. Philadelphia: W.B. Saunders Company; 1998. p.19-48. 14. Gries E, Singer MV, Goebell H. Amyloidosis in Crohn disease. Case reports and review of the literature. Med Klin (Munich) 1989;84:65-71. 15. Friedman S, Janowitz HD. Systemic amyloidosis and the gastrointestinal tract. Gastroenterology Clin North Am 1998;27:595-614. 16. Cathcart ES. Amyloidosis. In: Kelley WN, Harris ED, Jr.,Ruddy S, Sledge CB, editors. Textbook of Rheuma- tology. Philadelphia: W.B. Saunders Company; 1993. p.1413-28. 17. Feurle GE. Pathophysiology of diarrhea in patients with familial amyloid neuropathy. Digestion 1987;36: 13-7.