The Patient with Recurrent Sinusitis and Vomiting

Three similar episodes had occurred in the prior 5 months. Further testing showed diffuse lymphadenopathy, hepatosplenomegaly, pancytopenia, and pulmonary and hepatic nodules (see Figure 1). Extensive testing for infection and malignancy was normal. The presence of hypogammaglobulinemia, an impaired pneumococcal vaccine response, and nonnecrotizing granulomas on lymph-node and gastric biopsies eventually led to the diagnosis of common variable immunodeficiency (CVID).