Common Variable Immunodeficiency (CVID) is a primary immunodeficiency of unknown etiology characterized by low serum IgG, a decreased ability to make specific antibodies, and variable T cell defects. Approximately 20% of patients with CVID develop clinical evidence of a diffuse parenchymal lung disease with a constellation of histopathological findings termed granulomatous and lymphocytic interstitial lung disease (GLILD). In this study, we characterized the histological and immunohistochemical features in a series of 16 cases diagnosed by open lung biopsy. Peribronchiolar and interstitial lymphocytic infiltration, granulomatous inflammation and organizing pneumonia were consistent features; interstitial fibrosis with architectural remodeling was also found in a subgroup of patients. By immunohistochemistry, a predominance of CD4+ T lymphocytes with variable numbers of CD8+ T cells and B cells were present, with a striking absence of FOXP3 positive T regulatory cells. This heretofore unrecognized immunohistochemical finding, needs further investigation for a potential role in the pathogenesis of the condition. The presence of interstitial fibrosis with or without architectural remodeling in a subset of patients also needs additional study, for effect on prognosis.

Transthoracic needle biopsy of small pulmonary nodules can produce diagnostic yields comparable with published results of transthoracic needle biopsy of larger lesions.

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