Najjar Iris, Paluca Florina, Loukidis Konstantinos, Tarr Philip E
University Department of Medicine, Kantonsspital Baselland, Bruderholz, University of Basel, 4101 Bruderholz, Switzerland.
Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, University of Basel, 4101 Bruderholz, Switzerland.
J Clin Med. 2020 Feb 18;9(2):553. doi: 10.3390/jcm9020553.
Recurrent 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 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 enteritis and hypogammaglobulinemia in the setting of non-Hodgkin lymphoma, chemotherapy, and maintenance rituximab. Physicians should be aware of the association of recurrent 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 enteritis and those starting rituximab should be investigated for hypogammaglobulinemia and B-lymphopenia.
复发性肠炎是原发性低丙种球蛋白血症的一种有充分记录的并发症，但在其他类型的免疫缺陷中仅有罕见报道，且在利妥昔单抗相关的继发性低丙种球蛋白血症后尚无病例报告。因此，我们查阅了本地微生物学实验室数据库并进行了文献检索，以详细描述与复发性肠炎相关的免疫缺陷状态。已发表的病例患有原发性低丙种球蛋白血症，最常见于常见变异型免疫缺陷、X连锁无丙种球蛋白血症和古德综合征的情况下。在利妥昔单抗或继发性低丙种球蛋白血症后，文献中未发现病例。我们报告了一名73岁的患者，在非霍奇金淋巴瘤、化疗和维持使用利妥昔单抗的情况下出现复发性肠炎和低丙种球蛋白血症。医生应意识到复发性肠炎与免疫缺陷的关联，最常见于原发性低丙种球蛋白血症。单独使用利妥昔单抗可能不足以导致免疫抑制从而发生复发性弯曲菌病；包括血液系统恶性肿瘤及其治疗在内的其他因素似乎是必要的。对于复发性肠炎患者和开始使用利妥昔单抗的患者，应调查是否存在低丙种球蛋白血症和B淋巴细胞减少症。
