Tailored Treatment is Successful for CVID Patients with Bronchiectasis

Tailored Treatment is Successful for CVID Patients with Bronchiectasis

sick manOften times, clinicians are unconcerned with the cause of bronchiectasis in patients. Clinicians usually diagnose a patient with post-infective or idiopathic bronchiectasis, and the different diagnoses have minimal impact on the routine treatment of bronchiectasis, as the cause is not perceived to be vital to managing the condition.

However, in the world of personalized medicine, knowing the cause of bronchiectasis allows patient-specific, tailored therapeutic regimens to lead to better condition management and recovery. One doctor in the Department of Pulmonary Medicine at Jawaharlal Institute of Postgraduate Medical Education and Research, Manoj Kumar Panigrahi, MD, investigated the cause of one patient’s bronchiectasis and found an uncommon cause for the condition — common variable immunodeficiency disorder (CVID).

As described in “Common Variable Immunodeficiency Disorder–An Uncommon Cause for Bronchiectasis,” the patient in the case study was a 34-year old male who came in to the doctor with a fever, severe cough, and intense breathlessness for a week. Since childhood, he had suffered from recurrent respiratory infections, along with recurrent diarrhea for the last seven years.

Before coming into the doctor, he had been treated twice in the past with empirical antitubercular therapy due to expected smear negative pulmonary tuberculosis and empyema thoracis, but he was still not well. Emaciated and wanting to feel well, the patient required additional treatment. Dr. Panigrahi diagnosed him with CVID.

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Treatment thus consisted of two weeks of intravenous ceftriaxone and ceftazidime, as intravenous Ig (IVIG) therapy was too cost-prohibitive. Standard treatment of CVID is IVIG every three to four weeks, with doses and frequency personalized to the patient for maximum success.

The patient had contracted bronchiectasis as a late manifestation in CVID, which was evident from repeated infections in the past. Bronchiectasis is the most common pulmonary pathology developed in patients with CVID, with up to 76% of CVID patients presenting the condition.

Fortunately, Dr. Panigrahi was able to treat the patient’s symptoms. He then stated, “Primary immunodeficiency should be considered as a possibility for bronchiectasis in young patients who have recurrent respiratory infections and multisystem involvement. Serum Ig estimation should be done in such patients.” If serum Ig is low, IVIG may be most suitable, but it appears as though alternate forms of treatment can be tailored to patients.

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