Refractory Pseudomonas aeruginosa Bronchopulmonary Infection After Lung Transplantation for Common Variable Immunodeficiency Despite Maximal Treatment Including IgM/IgA-Enriched Immunoglobulins and Bacteriophage Therapy
Manon Levêque, Nadim Cassir, Fanny Mathias, Cindy Fèvre, Florence Daviet, Julien Bermudez, Geoffrey Brioude, Florence Peyron, Martine Reynaud‐Gaubert, Benjamin Coiffard
Abstract
Abstract: Recipients transplanted for bronchiectasis in the context of a primary immune deficiency, such as common variable immunodeficiency, are at a high risk of severe infection in post-transplantation leading to poorer long-term outcomes than other transplant indications. In this report, we present a fatal case due to chronic Pseudomonas aeruginosa bronchopulmonary infection in a lung transplant recipient with common variable immunodeficiency despite successful eradication of an extensively drug-resistant (XDR) strain with IgM/IgA-enriched immunoglobulins and bacteriophage therapy. The fatal evolution despite a drastic adaptation of the immunosuppressive regimen and the maximal antibiotic therapy strategy raises the question of the contraindication of lung transplantation in such a context of primary immunodeficiency. Keywords: primary immunodeficiency diseases, lung transplantation, Pseudomonas aeruginosa , phage therapy, immunoglobulin therapy