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An Unusual Case of Sinusitis
  1. Major LEM Lamb, MA MRCP DTM&H RAMC, Specialist Registrar in Infectious Diseases and General (Internal) Medicine1,
  2. P Richards, Regional Consultant in Occupational Medicine2 and
  3. JDM Edgar, Consultant Immunologist3
  1. 1Chelsea and Westminister Hospital, 369 Fulham Road, London, SW10 9NH
  2. 2Army Primary Health Service, North-East, Permanent Standing Medical Board, Duchess of Kent Barracks, Catterick Garrison, North Yorkshire, DL9 4DF
  3. 3Regional Immunology Service, Immunology Day Centre, Royal Group of Hospitals Trust, Grosvenor Road, Belfast, BT12 6BN.
  1. 124A Barons Court Road, London, W14 0DT lucybaker45{at}hotmail.com

Abstract

Background Common Variable Immunodeficiency (CVID) is the commonest form of severe antibody deficiency. It is characterized by reduced levels of IgG (<400mg/dL) and low IgA and/or IgMlevels, recurrent bacterial infections, impaired antibody responses despite the presence of B Cells and normal or near normal T immunity in 60% of patients. There is a high mortality from infections without treatment. The main stay treatment is to replace the immunoglobulins.

Case Presentation We describe a British soldier with a 10 year history of recurrent chest infections, sinusitis and otitis media. He repeatedly presented 2 to 3 times a year complaining of either a green nasal discharge or a cough productive of yellow/green sputum. He presented three years ago with severe sinusitis which resulted in investigations highlighting hypogammaglobulinaemia. Subsequently he was started on immunoglobulin therapy with Flebogamma 40g three weekly.

Recommendations Despite being a relatively rare condition, CVID when diagnosed, can be easily treated and improve patients' prognosis. Medical Officers should be aware of the condition as a differential diagnosis for individuals presenting with recurrent infections.

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