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CVID — RACP Adult Medicine MCQ

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HardInfectious DiseasesCVIDRACP Adult Medicine

An adult has recurrent bacterial respiratory infections, bronchiectasis, IgG 3.1 g/L, low IgA, poor pneumococcal vaccine responses and reduced switched-memory B cells. Before diagnosing CVID and starting lifelong immunoglobulin, what is essential?

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Correct answer: B — Exclude secondary causes and confirm persistent functional antibody failure

The best answer is “Exclude secondary causes and confirm persistent functional antibody failure”. CVID is a diagnosis of exclusion requiring persistent low immunoglobulins and impaired antibody function after protein loss, malignancy, medicines and other secondary causes have been considered. Adult onset does not establish a secondary disorder, and reduced switched-memory B cells do not establish X-linked agammaglobulinaemia. A normal neutrophil count assesses a different immune compartment.

Reference: ASCIA, Primary immunodeficiency: https://www.allergy.org.au/patients/immunodeficiencies/primary-immunodeficiency