Case

A middle-aged woman with common variable immunodeficiency (CVID) presented with progressive dyspnoea and fevers. She had a temperature of 38.9°C, oxygen saturation of 91% on room air and decreased breath sounds at the lung bases. Her lab showed pancytopaenia. Chest CT revealed diffuse ground-glass opacities, hilar and mediastinal lymphadenopathy, and right lower lobe consolidation (figure 1). She received empiric broad-spectrum antibiotics without improvement. An infectious work-up and lymph node biopsy were unremarkable. Bronchoscopy with transbronchial biopsy showed dense bronchial wall lymphoid infiltrates with non-caseating granulomas (figure 2). Bacterial, mycobacterial, fungal and …