Nodular lymphoid hyperplasia in common variable immunodeficiency syndrome mimicking familial adenomatous polyposis on endoscopy

Abstract

Common variable immunodeficiency syndrome (CVID) includes a heterogeneous disorder characterized by reduced levels of IgG, IgA or IgM, and recurrent bacterial infections with normal T-cell immunity in 60% of patients. It affects the gastrointestinal tract as the largest immune organ with a wide spectrum of symptoms and signs. We present a case of nodular lymphoid hyperplasia (NLH) of the small intestine in a 31-year-old man admitted for evaluation of chronic diarrhea. Upper and lower gastrointestinal endoscopy revealed multiple polyps in the stomach, duodenum, ileum, and large intestine mimicking familial adenomatous polyposis (FAP). Although he had no history of recurrent infection, immunological profiles were in favor of CVID. We emphasize the importance of considering CVID in any patient with gastrointestinal manifestations even in the absence of recurrent bacterial infections. Diagnostic delay results in more morbidity and complications in untreated patients.

Duodenal bulb nodularity: an endoscopic sign of cow's milk protein allergy in infants?

“…1 However, the observation of duodenal LNH alone cannot be considered as diagnostic of food allergy. It is described in other conditions, including celiac disease, 6 H pylori infection, 7 common variable immunodeficiency, 8 IgA deficiency, 9 and giardiasis. 10 None of our patients had these conditions.…”

Nodular Lymphoid Hyperplasia in a Patient Initially Believed to Have Familial Adenomatous Polyposis

“…Mahsa et al reported a case of NLH mimicking FAP wherein they attributed the misdiagnosis to similarities in the polyplike appearance on endoscopy and large lymphoid follicles in the lamina propria on histology. 1 Studies have shown that infection with Giardia lamblia may create a nodular mucosal pattern. 2…”

Inflammatory and infectious manifestations of immunodeficiency in the gastrointestinal tract

“…Endoscopic findings are variable; the mucosa may be normal or show diffuse erythema, friability, and ulcers [5]. Lymphoid hyperplasia with mucosal nodularity is common, particularly the duodenum [6].…”