Small intestinal nodular lymphoid hyperplasia as the manifestation of common variable immunodeficiency in a patient with celiac disease

We report on the case of a 25 years old woman, with a history of hypogammaglobulinemia from the age of 14 years, who was admitted to a county hospital due to diarrhoea and edema of the lower extremities.

By the results of the examinations performed, Crohn's disease was suggested as the possible cause of the symptoms. She was transferred to our Department for further investigations and treatment.

Immunoelectrophoresis, the quantitative measurement of immunoglobulins, gastroscopy and colonoscopy (with respect to the terminal ileum) raised the possibility of nodular lymphoid hyperplasia as the manifestation of common variable immunodeficiency. The complete small intestines proved to be affected by capsular enteroscopy and CT enterography. The possibility of malignancy was precluded. Biopsies were taken and the histological examination showed celiac disease and G. lamblia infection. The majority of the lymphocytes infiltrating the mucosa were atypical, CD3 positive T cells.

After the treatment of Giardiasis and the introduction of gluten free diet her complaints improved, however, neither the macroscopic nor the microscopic view of the small intestines showed significant changes.

Thus we concluded that the polypoid lesions of the small intestine were the manifestations of nodular lymphoid hyperplasia due to common variable immunodeficiency and celiac disease.