A Rare But Significant Cause of Recurrent Pseudomonas Tonsilitis: Common Variable Immunodeficiency

Abstract

Upper respiratory tract infections (URTI) one of the most common clinical situations encountered by primary care physicians and internal medicine specialists. Viruses are the most common etiologic cause and the clinical picture is usually self-limiting. However, the symptoms of viral URI are substantially similar to those of major pharyngitis agents such as group A Streptococcus (GAS). When atypical presentations and atypic bacterial infections are suspected, microscopic examination of the throat culture is a frequently used laboratory test. Atypical microorganisms detected as a result of throat culture are evaluated as laboratory error and / or contamination and apossible underlying immunodeficiency conditions are overlooked. The diagnosis of the patients is delayed due to the perception of immune deficiency as childhood diseases and the lack of awareness in this regard. In this case, we aimed to present a patient with recurrent tonsillopharyngitis complaints whose first throat culture results was possitive for a gram (-) microorganism and second throat culture was positive for pseudomanas aerigunosa. As a result of further investigations of the patient's lung, bronchiectasis sequelae and diminished count of switched memory B cells were detected. The patient was diagnosed with common variable immunodeficiency, and her complaints disappeared completely with 400 mg / kg intravenous immunoglobulin replacement. In conclusion, it is very important to evaluate the patients especially in the presence of stimulant signs in terms of immunodeficiency, or to refer them to the Immunology department, to manage the complications.