Recurrent Bacteremia as the First Manifestation of Hypogammaglobulinemia: a Case Report and Literature Review.

A 30-year-old woman with a past medical history of autoimmune hemolytic anemia presented with fever. Blood cultures grew . Her medical history was significant for four prior episodes of gastroenteritis and bacteremia. She received ciprofloxacin for the index presentation, then Meropenem de-escalated to doxycycline 6 months later following recurrence of . This prompted investigation for an immunodeficiency disorder. She was found to have hypogammaglobulinemia. Her infections resolved following the administration of intravenous immunoglobulins every 3 weeks. She did not have recurrence of during 5 years of follow-up. A literature search revealed additional four case reports of six hypogammaglobulinemic adult individuals presenting with recurrent infections. Three patients were already on intravenous immunoglobulin (IVIG) when infection occurred, and two patients achieved clinical cure following therapy with imipenem and IVIG. This case report highlights the importance of suspecting hypogammaglobulinemia in patients with recurrent infections, as this is sometimes the first manifestation of the condition.