RecurrentC. difficilein a Patient with IgG Deficiency

Asad Jehangir,Richard Alweis,Bilal Shaikh,Anam Qureshi,Shoaib Bilal Fareedy,Kyle Bennett,Qasim Jehangir,Andrew Rettew

doi:10.1155/2015/356293

Abstract

IgG deficiency can predispose to recurrent pyogenic infections. The association of IgG deficiency with Clostridium difficile infection has been infrequently reported in the literature. We present a case of a middle-age woman with multiple hospitalizations for recurrent C. difficile in a short span of time which prompted consideration of a possible fecal transplant. On evaluation, she was found to have low total IgG, with subclass analysis revealing low IgG1 and IgG3. She was started on monthly infusions of immunoglobulins and one year after her last episode of C. difficile she has not had any recurrence. The role of immunoglobulin infusion in the treatment of recurrent C. difficile is controversial, with some studies revealing no clear evidence of benefit. Our case report suggests that the patients who have underlying IgG deficiency may benefit from immunoglobulin, as this can significantly reduce the incidence of recurrent infections and hence save the healthcare costs.

Highlights

We present a case of a middle-aged female with 3 episodes of C. difficile colitis within a 4-month period who was found to have IgG1 and IgG3 deficiency on evaluation and had no recurrences after the initiation of immunoglobulin infusions (IVIG)
Low levels of immunoglobulin G (IgG) confirmed on repeat testing along with 3 episodes of C. difficile colitis in a short interval of time helped us establish a diagnosis of IgG deficiency
There have been very few case reports of IgG deficiency in patients with recurrent C. difficile colitis that improved with immunoglobulin replacement [6]

Summary

Introduction

Low levels of immunoglobulin G (IgG) or one of its subclasses can be detected on laboratory testing in up to 20% of the population but predispose only a small subset of these patients to recurrent pyogenic infections like Streptococcus pneumonia [1, 2]. The association of IgG deficiency with Clostridium difficile has been rarely reported in the literature. We present a case of a middle-aged female with 3 episodes of C. difficile colitis within a 4-month period who was found to have IgG1 and IgG3 deficiency on evaluation and had no recurrences after the initiation of immunoglobulin infusions (IVIG)

Case Report

Discussion

Findings

Conclusion