Turning walking pneumonia into recurrent abscesses: a curious case of CVID and review of the literature

Abstract

Background Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder associated with a broad symptom presentation that is still being characterized. We report a rare case of recurrent mycoplasma skin abscesses in a patient with a history of autoimmune disorders and prolonged mycoplasma pneumonia who was diagnosed with CVID. Case presentation A 34-year-old woman presented with a history of recurrent abscesses previously confirmed positive for Mycoplasma pneumoniae. Her past medical history of recurrent mycoplasma abscesses, prolonged mycoplasma pneumonia, and autoimmune disorders (mixed connective tissue disease and immune thrombocytopenia) raised suspicion of CVID. Workup included negative anti-mycoplasma antibody titers, hypogammaglobulinemia, and negative anti-pneumococcal antibody titers despite prior vaccination, solidifying the diagnosis of CVID. The patient was discharged on antibiotic and intravenous immunoglobulin therapy and now follows allergy and immunology long-term for treatment. Conclusions Her diagnostic history underscores the importance of considering the various criteria of CVID for diagnosis, and her unique presentation of M. pneumoniae skin abscesses highlights the broad sequelae patients with CVID can manifest.

Mycoplasma pneumoniae Infections and Primary Immune Deficiencies

“…Actually, the same group previously also described the repeated isolation of M. pneumoniae from the knee joint of an adult patient with chronic polyarthritis who was also affected by an unspecified form of hypogammaglobulinemia [30]. Other reports described extrapulmonary infections (septic arthritis, osteomyelitis, encephalitis, and skin abscess) by M. pneumoniae in adult patients affected with moderate-severe hypogammaglobulinemia [31][32][33][34]. Moreover, unusual and/or prolonged infections by other Mycoplasma spp.…”

“…Other reports described extrapulmonary infections (septic arthritis, osteomyelitis, encephalitis, and skin abscess) by M . pneumoniae in adult patients affected with moderate-severe hypogammaglobulinemia [ 31 – 34 ]. Moreover, unusual and/or prolonged infections by other Mycoplasma spp.…”