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Common variable immunodeficiency with infective bronchiectasis exacerbation — SCE Acute Medicine MCQ

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HardAllergy and immunologyCommon variable immunodeficiency with infective bronchiectasis exacerbationSCE Acute Medicine

A 36-year-old man with common variable immunodeficiency presents with fever, cough and hypoxia. Chest CT shows bronchiectasis with new tree-in-bud nodularity. He receives immunoglobulin replacement but missed two infusions. Sputum has repeatedly grown Haemophilus influenzae. What is the most appropriate next step in management?

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Correct answer: D — Treat infection promptly and liaise with immunology about replacement therapy and prevention strategy

Patients with antibody deficiency and bronchiectasis are at high risk of bacterial respiratory infection and need prompt antimicrobial treatment, sputum microbiology and immunology review of replacement therapy. Infection despite treatment does not mean immunoglobulin should be stopped; dosing, adherence and bronchiectasis care need review. Preventing recurrent infection is part of acute and longitudinal management.

Reference: British Society for Immunology guidance; BTS bronchiectasis guideline