D3.328 - Relapsing COVID-19 pneumonia and Helicobacter cineadi cellulitis in a patient with X-linked agammaglobulinemia
Case report
Introduction: X-linked agammaglobulinemia is a primary humoral immunodeficiency characterized by the absence of mature B lymphocytes and immunoglobulins.
Patient report: A 40-year-old man who was diagnosed with agammaglobulinemia at the age of 13 months. The patient received regular immunoglobulin replacement therapy. He was treated for pneumonia caused by infection with the SARS-CoV-2 virus for the first time in April 2020 with the use of convalescent plasma and tocilizumab. After the complete resolution of the complaints and the normalization of the X-ray findings, the first, and after that, three more relapses of pneumonia occur with repeated negative findings of the presence of the virus in the nasopharyngeal swab. Tocilizumab was administered in a monthly dose of 800 mg consecutively for three months during which the patient was symptom-free. After reducing the dose of tocilizumab to 400 mg, a relapse of pneumonia occurred, when the presence of the virus was detected in the sputum. He was successfully cured using remdesivir for 10 days. In August 2022, skin redness appear on the lower legs that correspond to cellulitis with increased inflammation markers. After discontinuation of antibiotic therapy, numerous recurrences of cellulitis occur. During the active phase of cellulitis, Helicobacter cineadi was isolated from prolonged blood culture and confirmed by MALDI-TOF mass spectrometry. The treatment was proceeded with the continuous administration of various combinations of antibiotics in total duration of 18 months. The patient has been symptom-free for the following 10 months. Unfortunately, in November 2024, the skin redness on the lower legs reappeared and antibiotics were reintroduced.
Conclusion: Antibodies are necessary for opsonization and removal of infectious agents. In the immunoglobulin preparations from the blood of numerous donors that our patient regularly received, there were probably not enough antibodies specific for SARS-CoV-2 and H. cineadi to eradicate these infections.
