title: Recurrent C. difficile in a Patient with IgG Deficiency.
abstract: IgG deficiency can predispose to recurrent pyogenic infections. The association of IgG deficiency with Clostridium difficile infection has been infrequently reported in the literature. We present a case of a middle-age woman with multiple hospitalizations for recurrent C. difficile in a short span of time which prompted consideration of a possible fecal transplant. On evaluation, she was found to have low total IgG, with subclass analysis revealing low IgG1 and IgG3. She was started on monthly infusions of immunoglobulins and one year after her last episode of C. difficile she has not had any recurrence. The role of immunoglobulin infusion in the treatment of recurrent C. difficile is controversial, with some studies revealing no clear evidence of benefit. Our case report suggests that the patients who have underlying IgG deficiency may benefit from immunoglobulin, as this can significantly reduce the incidence of recurrent infections and hence save the healthcare costs.
authors.affiliation: Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA 19610, USA.
authors.forename: Asad
authors.identifier: 0000-0003-3178-6264
authors.initials: A
authors.lastname: Jehangir
authors.affiliation: Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA 19610, USA.
authors.forename: Kyle
authors.identifier: 0000-0001-5784-8529
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA 19610, USA.
authors.forename: Shoaib Bilal
authors.initials: SB
authors.lastname: Fareedy
authors.affiliation: Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA 19610, USA.
authors.forename: Andrew
authors.identifier: 0000-0003-4358-8230
authors.initials: A
authors.lastname: Rettew
authors.affiliation: Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA 19610, USA.
authors.forename: Bilal
authors.identifier: 0000-0002-7033-3826
authors.initials: B
authors.lastname: Shaikh
authors.affiliation: King Edward Medical University, Mayo Hospital Road, Nelagumbad, Anarkali, Lahore 54000, Pakistan.
authors.forename: Anam
authors.identifier: 0000-0002-5057-0883
authors.initials: A
authors.lastname: Qureshi
authors.affiliation: Rawalpindi Medical College, Tipu Road, Rawalpindi 46000, Pakistan.
authors.forename: Qasim
authors.identifier: 0000-0003-2980-067X
authors.initials: Q
authors.lastname: Jehangir
authors.affiliation: Department of Internal Medicine, Reading Health System, 6th Avenue and Spruce Street, West Reading, PA 19610, USA ; Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Richard
authors.identifier: 0000-0002-4747-8066
authors.initials: R
authors.lastname: Alweis