Endocrine Abstracts

Background: Common Variable Immunodeficiency syndrome (CVID), the most common symptomatic immunodeficiency in aduIts, is characterized by diminished levels of IgG, IgA and/or IgM, and recurrent bacterial infections. The gastrointestinal (GI) manifestations of CVID are rare and variable. We herein report the case of a patient with a severe hypocalcemia secondary to digestive tract involvement of the CVID syndrome.

Case report: A 32 year-old female patient with a history of CVID and recurrent lung infections was admitted to our department for exploration of deep hypocalcemia. She complained of weight loss, asthenia and paresthesia of the lower limbs.She also reported abdominal pain and diarrhea. The physical examination revealed a weight a body mass index of 17.6 kg/m² and a a homogeneous hepatosplenomegaly. Trousseau sign was elicited. Biochemical tests noted hypocalcemia of 57 mg/l, hypophosphoremia of 10 mg/l, hypokalemia of 2.7 mmol/l, hypomagnesemia of 10 mg/l and hypoalbuminemia of 25.8 g/l. Hypochromic microcytic anemia of 7.9 g/dl was also found. The hormonal assessment revealed hyperparathyroidism secondary to vitamin D deficiency. Thyroid assessment and coeliac disease serology were normal.Electrocardiogram showed sinus tachycardia, an elongated QT space and diffuse negative T waves. Upper endoscopy and duodenal biopsy were normal. Computed tomography enterography didn´t show any thickening of the bowel wall. Colonoscopy showed a normal appearance of colonic mucosa but colonic histology revealed a chronic colitis with moderate activity related to its CVID syndrome.

Conclusion: GI manifestations in CVID are mainly dominated by chronic diarrhea. This diarrhea can be due to chronic infections with Giardia lamblia but also resulting from specific lesions of the intestinal mucosa such as villous atrophy mimicking celiac disease.