Successful treatment of common variable immunodeficiency disorder-associated diarrhea with budesonide: A case report

PURPOSE: Common variable immunodeficiency disorder (CVID) is an immunological disease that can present with gastrointestinal (GI) symptoms including chronic diarrhea and abdominal pain. We report a patient with CVID and chronic diarrhea who significantly improved with budesonide. METHODS: A 47-yr-old woman with CVID-associated diarrhea, steatorrhea, abdominal pain, and bloating for several years had an exhaustive evaluation for secondary causes of her symptoms, which was unrevealing. At the advice of her immunologist, she attempted a course with budesonide that significantly improved her GI symptoms. Given the absence of literature on this treatment in CVID, we attempted to systematically evaluate the clinical benefits after withdrawal of and retreatment with budesonide. RESULTS: Diarrhea, steatorrhea, abdominal pain, and bloating recurred within 2 days of discontinuing budesonide. All parameters assessed improved upon reinitiating budesonide. Further, serum immunoglobulin G (IgG) levels significantly increased with treatment. No significant side effects were observed with budesonide. CONCLUSION: This is the first report of a patient with CVID-related chronic diarrhea to be successfully treated with oral budesonide. This observation provides clinicians with an effective and safe treatment option in this difficult group of patients.