P0135 - Stones, Steatosis, and Surprises: A Rare Case of Pancreatitis in Common Variable Immunodeficiency

Syeda Kanza Kazmi, MD¹, Theja V. Channapragada, DO, MBA, MS¹, Syeda Mansoor, MBBS², Kuldeep Kaur Randhawa, MBBS³, Rohit Jain, MD¹
1Penn State Health Milton S. Hershey Medical Center, Hershey, PA; 2Dow Medical College, Hershey, PA; 3Government Medical College, Patiala, Punjab, INDIA, Brampton, ON, Canada

Introduction: Common variable immunodeficiency (CVID) is the most frequent symptomatic primary immunodeficiency, marked by impaired antibody production [1]. Although gastrointestinal (GI) complications are frequent, particularly enteropathy and infections, biliary and pancreatic involvement is rarely reported[1,2]. This case highlights a rare co-presentation of acute pancreatitis and cholelithiasis in a young woman with CVID.

Case Description/

Methods: A 26-year-old female with CVID on immunoglobulin (Hizentra), metabolic-associated cirrhosis and asthma presented with three days of diffuse abdominal pain, diarrhea, nausea, and vomiting. Labs revealed leukocytosis, transaminitis and lipase 1519 U/L. Abdominal ultrasound showed gallstones with wall thickening and a positive Murphy sign. MRI revealed hepatic steatosis, gallstones without biliary dilation, and generalized mesenteric edema. No pancreatic mass or ductal irregularity was seen. She was managed conservatively and underwent cholecystectomy. Post surgery, her symptoms subsided, and her labs normalised.

Discussion: GI manifestations occur in upto 20% of CVID cases, often mimicking IBD or celiac disease [1]. Pancreatitis is rarely described, usually in immune dysregulation (e.g., LRBA deficiency) or autoimmunity [2]. Gallbladder disease is more commonly reported in pediatric CVID, especially with autoimmune hemolytic anemia or chronic inflammation [3]. Chronic immune activation, hepatobiliary inflammation, or lipid metabolism issues may contribute [3]. While gallstones caused her pancreatitis, cirrhosis and immune dysfunction likely played a role. This case emphasizes the need to maintain a broad differential in CVID patients with abdominal pain, including pancreatobiliary etiologies.

References:
1-Ho, H., & Cunningham-Rundles, C. (2020). Non-infectious complications of common variable immunodeficiency: updated clinical spectrum, sequelae, and insights to pathogenesis. Frontiers in Immunology, 11. https://doi.org/10.3389/fimmu.2020.00149
2-Ravindran, D., Mugunthan, R. S. R., Shruthi, T. K., & Jayaraman, D. (2022). Severe diabetic ketoacidosis and autoimmune pancreatitis with SIRS in an adolescent with LRBA deficiency – A rare complication of a common primary immunodeficiency disease. Journal of Family Medicine and Primary Care, 11(4), 1552–1554. https://doi.org/10.4103/jfmpc.jfmpc_1220_21
3-Kutluğ Ş, et al. (2019). Development of multiple gallstones in a child with lipopolysaccharide-responsive beige-like anchor protein mutation. Clin Immunol, 201: 20–23

Disclosures:
Syeda Kanza Kazmi indicated no relevant financial relationships.
Theja Channapragada indicated no relevant financial relationships.
Syeda Mansoor indicated no relevant financial relationships.
Kuldeep Kaur Randhawa indicated no relevant financial relationships.
Rohit Jain indicated no relevant financial relationships.

Syeda Kanza Kazmi, MD¹, Theja V. Channapragada, DO, MBA, MS¹, Syeda Mansoor, MBBS², Kuldeep Kaur Randhawa, MBBS³, Rohit Jain, MD¹. P0135 - Stones, Steatosis, and Surprises: A Rare Case of Pancreatitis in Common Variable Immunodeficiency, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.