A “strange” case of COPD

Common variable immunodeficiency (CVID) is a rare syndrome, characterized by hypogammaglobulinemia and limited antibody responses due to either impaired B-lymphocyte development or B-cell responses to T-lymphocyte signals. CVID is frequently associated with bacterial infections, particularly against respiratory tract, that could determine a permanent organ damage (COPD, asthma), increased incidence of both autoimmune diseases and cancer, high prevalence of gastrointestinal inflammatory diseases (ulcerative colitis, Crohn’s disease, celiac disease), lymphoproliferative and granulomatous diseases. Given that the gastrointestinal tract is the largest lymphoid organ in the body, it’s not surprising that intestinal diseases are common in immunodeficiency. CVID is considered a congenital condition but it is usually diagnosed in adulthood. We describe the case of a 43-year-old man affected by recurrent infections of respiratory tract with CVID, celiac disease and type 1 diabetes. With the exclusion of gluten from the diet, patient achieved an improvement of serum level of immunoglobulins and a reduction of recurrent infections. This fact suggests that the interruption of the gluten stimulus could have a positive influence on the other diseases, improving the metabolic compensation and stabilizing the immune system.