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

[CIS-PIDD]

Dear Will,

I know it may sound counter-intuitive but I have had several successes with oral Igs where all other treatments had failed...

Isabelle Meyts
UZ Leuven
Belgium




> Op 19-dec.-2016 om 21:05 heeft CIS-PIDD <cis-pidd at lists.clinimmsoc.org> het volgende geschreven:
> 
> 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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