Recurrent Campylobacter Enteritis in Patients with Hypogammaglobulinemia: Review of the Literature.

Iris Najjar,Konstantinos Loukidis,Philip E Tarr,Florina Paluca

doi:10.3390/jcm9020553

Abstract

Recurrent Campylobacter enteritis is a well-recorded complication of primary hypogammaglobulinemia but has only rarely been reported with other types of immunodeficiency, and no cases have been reported after rituximab-associated secondary hypogammaglobulinemia. We therefore reviewed our local microbiology laboratory databases and conducted a literature search, to provide a detailed characterization of the immunodeficiency states associated with recurrent Campylobacter enteritis. Published cases had primary hypogammaglobulinemia, most frequently in the setting of common variable immunodeficiency, x-linked agammaglobulinemia, and Good syndrome. No cases were identified in the literature after rituximab or secondary hypogammaglobulinemia. We report a 73-year-old patient with recurrent Campylobacter enteritis and hypogammaglobulinemia in the setting of non-Hodgkin lymphoma, chemotherapy, and maintenance rituximab. Physicians should be aware of the association of recurrent Campylobacter enteritis and immunodeficiency, most commonly in primary hypogammaglobulinemia. Rituximab alone may not be sufficiently immunosuppressive for recurrent campylobacteriosis to occur; additional factors, including hematological malignancy and its treatment, appear necessary. Patients with recurrent Campylobacter enteritis and those starting rituximab should be investigated for hypogammaglobulinemia and B-lymphopenia.

Highlights

In healthy individuals, campylobacteriosis presents variably with diarrhea, abdominal pain, and fever
We report the case of a man who developed recurrent Campylobacter enteritis, in the setting of secondary hypogammaglobulinemia due to non-Hodgkin lymphoma and repeated administration of rituximab as maintenance lymphoma treatment
Our literature review of recurrent Campylobacter enteritis and immunodeficiency yielded 14 cases associated with hypogammaglobulinemia [22,23,24,25,26,27,28,29,30,31,32], all of which were considered to be primary, and most commonly included common variable immunodeficiency (CVID) and X-linked hypogammaglobulinemia (XLA) [1]

Summary

Introduction

Campylobacteriosis presents variably with diarrhea, abdominal pain, and fever. Successful treatment often requires antibiotics and intravenous immune globulin replacement (IVIG) [1]. While it is a well-recorded complication in primary hypogammaglobulinemia, recurrent campylobacteriosis in patients with secondary hypogammaglobulinemia has not previously been recorded and is rare with other types of immunodeficiency. We provide a detailed review of the literature of recurrent Campylobacter enteritis in the setting of immunodeficiency. Our review shows that recurrent Campylobacter gastroenteritis has been reported most commonly in the setting of primary hypogammaglobulinemia and only rarely in other immunodeficiency states. We report the case of a man who developed recurrent Campylobacter enteritis, in the setting of secondary hypogammaglobulinemia due to non-Hodgkin lymphoma and repeated administration of rituximab as maintenance lymphoma treatment. Screening for hypogammaglobulinemia is recommended prior to starting rituximab

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