minocycline and Agammaglobulinemia

Topics: Agammaglobulinemia; Anti-Bacterial Agents; Diagnosis, Differential; Helicobacter; Helicobacter Infections; Humans; Immunocompromised Host; Leg; Male; Middle Aged; Minocycline; Pyoderma Gangrenosum

A patient genetically diagnosed with X-linked agammaglobulinemia repeatedly developed bacteremia due to Campylobacter coli (C. coli) for one year and seven months in spite of immunoglobulin replacement therapy. Throughout the clinical course, C. coli with identical genetic patterns was repeatedly isolated from both blood and stool cultures, thus indicating that the patient had latent intestinal infection. The bacteremia was always accompanied by reactive arthritis. Since the immunoglobulin level was extremely low with severe B cell deficiency, the reactive arthritis must have been induced in a humoral immunity-independent manner. Adding oral minocycline following intravenous meropenem was very effective; the stool cultures became negative and the patient has been well for more than one year without relapse of bacteremia.

Topics: Administration, Oral; Adult; Agammaglobulinemia; Anti-Bacterial Agents; Arthritis, Reactive; Bacteremia; Campylobacter coli; Campylobacter Infections; Chromosomes, Human, X; Feces; Genetic Linkage; Humans; Injections, Intravenous; Intestinal Diseases; Male; Meropenem; Minocycline; Recurrence; Thienamycins; Treatment Outcome

Seven to 22% of patients with agammaglobulinemia develop joint manifestations consisting of septic arthritis or aseptic arthritis of unclear pathogenesis. Intravenous gammaglobulin therapy seems effective on the latter condition but is burdensome and expensive. We report the case of a patient with common variable immunodeficiency and aseptic oligoarthritis in which minocycline therapy was effective in relieving the joint symptoms.

Topics: Agammaglobulinemia; Arthritis; Common Variable Immunodeficiency; Female; Humans; Middle Aged; Minocycline