a client with common variable immunodeficiency (cvid) comes to the ed reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. an assessment reveals abdominal tenderness, weight loss, and loss of reflexes. a gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. based on these findings, what common secondary problem has this client developed?