Nodular Lymphoid Hyperplasia
An 18-year-old woman presented with recurrent episodes of diarrhea associated with epigastric discomfort and bloating. Examination of the stool revealed trophozoites of the species Giardia lamblia. She underwent gastroduodenoscopy, which revealed numerous nodules in the duodenum (Panel A). Multiple biopsies of the nodules were performed, and histologic examination of the specimens revealed normal villi with prominent lymphoid follicles in the lamina propria, findings consistent with nodular lymphoid hyperplasia (Panel B). Further evaluation revealed evidence of hypoglobulinemia and low levels of IgG, IgA, and IgM in serum. A diagnosis of common variable immunodeficiency with nodular lymphoid hyperplasia was established. Approximately 20% of patients with common variable immunodeficiency may have nodular lymphoid hyperplasia, a condition that can mimic gastrointestinal polyposis. Nodular lymphoid hyperplasia may be associated with symptoms such as diarrhea and malabsorption in some patients, whereas other patients may be asymptomatic. The patient’s diarrhea abated with metronidazole treatment; she was counseled about the risk of infection associated with common variable immunodeficiency.
