Conclusions

Delayed diagnosis of CVID remains a major clinical challenge because of its heterogeneous presentation and the absence of specific early manifestations. This case illustrates that recurrent pneumonia associated with persistent generalized lymphadenopathy may represent the initial presentation of CVID, even in patients without a previous history of immunodeficiency. When infectious, granulomatous, and malignant causes have been excluded, serum protein electrophoresis may serve as an inexpensive screening test and should prompt quantitative immunoglobulin measurement when hypogammaglobulinemia is suspected. Early recognition of CVID is essential to initiate immunoglobulin replacement therapy promptly, prevent irreversible pulmonary complications, and improve long-term outcomes.