A Hepatitis C-Positive Patient with New Onset of Nephrotic Syndrome and Systemic Amyloidosis Secondary to Common Variable Immunodeficiency

Common variable immunodeficiency (CVID) is a heterogenous group of predominantly antibody deficiency disorders that make up the greatest proportion of patients with symptomatic primary hypogam maglobulinemia The rare coincidence of amyloidosis and hypogamma globulinemia has been reported previously Contrary to the usual insidious slowly progressive disease following hepatitis C infection a rapidly progressive cirrhotic form can develop in hypogammaglobulinemic patients We report a HCV positive patient with a new onset of nephrotic syndrome and systemic amyloidosis secondary to CVID Blood analyses showed serum creatininne of 1 8 mg/dL and serum albumin of 3 1 gm/dL 24 h urinary protein was 11 800 mg/day Serum immunoglobulin levels were IgG 340 mg/dL IgM 18 mg/dL IgA 11 mg/dL Duodenal biopsy revealed AA type amvloidosis with potassium permanganite and Congo red staining After a month of antiprotemuric therapy the proteinurin was reduced to 3350 mg/day