A 50-year-old female patient came to our clinic from another center for chronic diarrhea.
The patient had a history of recurrent cough with expectoration, fever and pleuritic pain since the age of 3 years. The patient underwent segmentectomy for purulent segmentectomy in the left lower lobe due to bronchiectasis at 15 years.
He also presented wound infection in the face at 4 years of age with cutaneous-parotid fistula and surgical resection with wound infection at 19 years of age.
Disability due to mental illness.
Sinusitis and recurrent suppurative sinusitis.
It is diagnosed with common variable immunodeficiency at 20 years and since then receives treatment with intravenous immunoglobulins every 3 weeks.
The current disease begins 1 year ago with an increase in its usual diarrhea, with multiple liquid stools up to 20 a day, without pathological products associated with abdominal pain and bloating.
In addition, he has lost 6 kg of weight in the last year.
On physical examination, the patient was conscious and oriented to regular general condition, hydrated and normal-choice.
Rhythmic cardiac tones, with no murmurs or signs of heart failure.
Respiratory mucus with decreased breath sounds in the left hemithorax.
The neurological examination was normal.
The abdomen blade, depressible, non-painful, without visceromegaly and peristalsis present.
A general analysis was performed without relevant changes, total proteins 6.8 g/dl, albumin 4.2 g/dl, erythrocyte sedimentation rate 10 mm/1 h, CRP 0.9 mg/dl 103 mg/200 antitrypsin.
Study of normal anaemias, negative anti-gliadin IgG and IgA antibodies, normal protein electrophoresis, lymphocytic immunophenotype: CD4 559, CD8 468 IgA deficiency, ICD4 / CD8 1,2, IgG
Outpatient fibrogastroscopy was performed up to the second portion of the duodenum that was normal with normal biopsy.
Negative duodenal aspirate culture for G.
Total fibrocolonoscopy and normal ileoscopy with normal biopsy were also performed.
Transient gastrointestinal tract with normal barium
Non-pelvic computed tomography showed no pathological changes.
Given the normality of the diagnostic tests, symptomatic treatment with diet and loperamide (up to 20 tablets/day) was performed without clinical improvement.
We decided to start treatment with budeson 3 mg three times a day for 3 months with progressive improvement of the entire clinical picture.
The patient currently has 1-2 stools per day (type 3-4 on the Bristol scale), pain and abdominal disfunction disappearing and significant improvement in quality of life.
