An unusual case of Campylobacter jejuni pericarditis in a patient with X-linked agammaglobulinemia

Abstract

INTRODUCTION X-linked agammaglobulinemia (XLA), also called Bruton agammaglobulinemia, is a relatively rare form of antibody deficiency seen in young males presenting with recurrent sinopulmonary infections. There have been several case reports of patients with XLA having refractory Campylobacter jejuni infections. There are also rare case reports of pericarditis because of Campylobacter organisms, and these have been reported in the elderly, AIDS patients, and other disease states. We report a case of C. jejuni pericarditis in a 32-yearold man with confirmed XLA and bronchiectasis that presented with fever, cough, and shortness of breath. He then developed progressive hypotension and signs suggestive of pericardial tamponade requiring emergent transthoracic pericardiocentesis, and later required placement of a pericardial window. Cultures from his pericardial fluid grew out a Gramnegative filamentous rod, which was later identified as C. jejuni. Several years later during an admission for pneumonia, he was found to have Campylobacter bacteremia. Subsequent blind colonic biopsies yielded positive specimens for C. jejuni in 6 of 6 specimens. Currently, he remains reasonably well, but despite a regimen of alternating macrolide/ fluoroquinolone antibiotics and intravenous immunoglobulin (Ig), he continues to grow Campylobacter from his stool.