Granulomatous and lymphocytic interstitial lung disease: a spectrum of pulmonary histopathologic lesions in common variable immunodeficiency--histologic and immunohistochemical analyses of 16 cases.

Academic Article

Abstract

  • Common variable immunodeficiency is a primary immunodeficiency of unknown etiology characterized by low serum immunoglobulin G, a decreased ability to make specific antibodies, and variable T-cell defects. Approximately 10-30% of patients with common variable immunodeficiency develop clinical evidence of a diffuse parenchymal lung disease with a constellation of histopathologic findings termed granulomatous and lymphocytic interstitial lung disease. In this study, we characterized the histologic and immunohistochemical features in a series of 16 cases diagnosed by open lung biopsy. Peribronchiolar and interstitial lymphocytic infiltration, granulomatous inflammation, and organizing pneumonia were consistent features; interstitial fibrosis with architectural remodeling was also found in a subgroup of patients. By immunohistochemistry, a predominance of CD4+ T lymphocytes with variable numbers of CD8+ T cells and B cells was present, with a striking absence of FOXP3-positive T-regulatory cells. This heretofore unrecognized immunohistochemical finding needs further investigation for a potential role in the pathogenesis of the condition. The presence of interstitial fibrosis with or without architectural remodeling in a subset of patients also needs additional study, for effect on prognosis.
  • Published In

  • Human Pathology  Journal
  • Keywords

  • Common variable immunodeficiency, Granuloma, Immunohistochemistry, Lymphoid interstitial lung disease, Organizing pneumonia, Adult, Biomarkers, Biopsy, Common Variable Immunodeficiency, Female, Granuloma, Respiratory Tract, Humans, Immunohistochemistry, Lung, Lung Diseases, Interstitial, Lymphocyte Subsets, Male, Middle Aged, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Rao N; Mackinnon AC; Routes JM
  • Start Page

  • 1306
  • End Page

  • 1314
  • Volume

  • 46
  • Issue

  • 9