Diarrhea and weight loss in common variable immunodeficiency: Campylobacter jejuni enterocolitis presenting as Crohn's disease - A case report

Background: Common Variable Immunodeficiency (CVID) is characterized by deficient antibody production. The manifestations of this condition are variables, in particular incidence of digestive tract infections in these patients is high, and Campylobacter jejuni is one of the most common pathogen involved. Autoimmune diseases, like inflammatory bowel disease (IBD), have higher prevalence in patients with CVID than in the general population. In this case report we were able to differentiate diarrheal relapses of inflammatory bowel disease from enteric atypical infections in a patient with hypogammaglobulinemia. Material and methods: A 45 year-old black patient was admitted for diarrhea, weight loss and abdominal pain in the past month and a history of recurrent bacterial infections of the respiratory tract. The diagnosis of CVID was established by demonstrating a significant reduction of plasma gamma-globulin levels. Colonoscopy and EGDS pointed to the presence of Crohn's disease which was confirmed histologically. Results: Mesalazine 2·4 g/day and methylprednisolone 1 mg kg-1 b.w./day were started but were uneffective on diarrhea and other gastrointestinal symptoms. A subsequent stool culture was positive for C. jejuni.A treatment with oral erythromicin 1·8 g/day for 1 week and s.c. human immunoglobulins one a month was started; diarrhea disappeared in one week while body weight increased progressively to normal in the following two months. Other gastrointestinal symptoms also disappeared. The patient is now totally recovered and symptomless. Conclusion: While the differential diagnosis between Crohn's disease and C. jejuni enterocolitis in patients with CVID can be difficult, immunosuppressive treatment for IBD may exacerbate C. jejuni infections. The high prevalence of enteric infections in patients with hypogammaglobulinemia suggests that all patients presenting with IBD clinical features should also undergo stool microbiological examination and, if positive, a trial with antibiotic therapy. By contrast, the concomitant use of corticosteroids may be unnecessary in this subgroup of patients.