[CIS PIDD] [cis-pidd] Sarcoid granulomatous disease (or lymphoma) and CVID

[dmvascon at usp.br]

Dear colleagues 


I would like to ask your advice on a case of a CVID patient, female, 24 years-old, born to a consanguineous couple, followed-up in our unit for 12 years. 
She is receiving IVIg replacement since diagnosis with adequate levels and significant clinical improvement of the infectious manifestations, maintaining only chronic sinusitis. 


One month ago she came to her IVIG replacement and told about the appearance of an inguinal lymphnode, asymptomatic and without signs of local inflammation. 
This lymphnode was tender to hard and she had two nodes at the other side, 2 cm diameter each. 
We asked for a biopsy (unfortunately the surgeon made an excisional biopsy of the smaller and didn't send to microbiological evaluation), despite the filled forms. 
The histopathological evaluation showed a well formed granuloma without central necrosis, negative for ACB, fungi and HHV8. 


A PET-CT showed several lymphnodes in the lower abdomen with high uptake of 18F-FDG (up to 11.5 SUV) in the inguinal region, abdomen and at the Waldeyer ring. It is important to remind that she has chronic sinusitis. 


My feeling is that these lymphnodes are affected by a lymphoma and therefore I would need to biopsy another lymphnode. 


Have you seen CVID sarcoid lesions with such a high SUV at 18F-FDG PET-CT? 
Do you think that it should be safe to try to treat as sarcoid for a while and observe the evolution? 


Thank you very much for your opinions. 


With my kind regards, 


Dewton Vasconcelos 


Dewton de Moraes Vasconcelos, MD, PhD 
University of São Paulo School of Medicine
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