Pre- and peri-hematopoietic cell transplant management of disseminated non-Helicobacter pylori Helicobacter infection in X-linked agammaglobulinemia: Case series and literature review

Non-Helicobacter pylori Helicobacter (NHPH) species are recognized as a cause of chronic systemic infection, cellulitis, and osteomyelitis in patients with X-linked agammaglobulinemia (XLA). Diagnosis and treatment are challenging due to fastidious growth, lack of standardized therapies, and frequent recurrence. We describe two cases of disseminated NHPH infection in XLA, including a patient where allogeneic hematopoietic cell transplant (HCT) was incorporated into management to achieve durable immune reconstitution and cure infection. One patient with disseminated Helicobacter bilis osteomyelitis discontinued antibacterials 14 months post-HCT following immune reconstitution. Another patient with disseminated Helicobacter cinaedi remains on antibacterials and is being evaluated for HCT. In select cases, HCT may represent a potential option to correct the immunodeficiency and enable infection clearance, with antibacterial therapy continued through HCT until systemic immunosuppression is withdrawn, immune reconstitution is documented, and infection resolves.