[CIS PIDD] [cis-pidd] FMT for C.Diff in CTLA4

[CIS-PIDD]

Dear all

We are managing a 70yr man with CTLA4 haploinsufficiency who has refractory clostridium difficile (ribotype 078) infection. We have tried 6 months oral vancomycin, 2 weeks oralmetronidazole, and multiple courses of fidaxomicin, but with no success. He has a background of hypogammaglobulinaemia (on IVIG with trough levels 11g/l), lymphocytic colitis, interstitial lung disease, and bronchiectasis. The initial C.Diff infection was probably due to courses of antibiotics for infective exacerbations of bronchiectasis.

Lymphocyte counts currently are;

CD3+ 1500 (cells/mm3)
CD4+ 440
CD8+ 1020
CD19+ 20
NK (CD16/56+) 120

IgG 11.4g/l
IgA <0.07
IgM <0.2

We are now considering a faecal microbiome transplant (FMT) via NJ tube. We feel the risk/benefit of infection from the FMT is less than that of the longterm C.Diff, and knock-on effects on quality of life and nutritional status.

Has anyone had any experience of FMT in patients with PIDD? Are there any additional precautions you would advise?

Many thanks 

Will



Dr William Rae
Clinical Immunology Specialist Registrar
NIHR RD-TRC Immunology Clinical Research Fellow
University Hospital Southampton, UK



 
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