A Case of Chronic Bronchobronchiolitis Associated with Hypogammaglobulinemia and Impaired Cellular Immunity

Common Variable Hypogammaglobulinemia?

Abstract

A 37 year-old nonsmoking man who complained of exertional dyspnea and cough was referred to our hospital by a local physician. Physical examination revealed finger clubbing, inspiratory moist and dry rales and expiratory dry rale in bilateral middle and lower lung fields. Chest radiograph disclosed a hyperlucent lung field with small nodular and linear shadows. Vital capacity (%VC 65.3%), forced expiratory volume in one second (FEV1.0% 30.5%) and arterial oxygen tension (Pao₂ 50torr) were all decreased, conversely, respiratory resistance (Rrs 8.0cmH₂O/L/sec), residual volume (%RV 153.8%) and arterial carbon dioxide tension (Paco₂ 45torr) were all increased. The histology of the open lung biopsy specimen showed chronic bronchobronchiolitis with interstitial pneumonia; infiltration of small round cells into bronchioles and alveolar septa with localized alveolar wall destruction. Immunologically, serum IgG, IgA and IgM were decreased accompanied with a normal cold agglutinin titer and there were decreases in lymphocyte blastogenic response to PHA, ConA and PWM with negative PPD skin reaction. There was also a slight increase in OKT4 and OKT10-positive T cells in peripheral blood.
Based on the data obtained in this case, we discussed the relationship between our case and diffuse panbronchiolitis or common variable hypogammaglobulinemia.