Enterohepatic Non-H. pylori Helicobacter Infection in a Patient With X-Linked Agammaglobulinemia

Non- H. pylori Helicobacter (NHPH) species are gram-negative, microaerophilic, spiral-shaped bacteria that can rarely cause recurrent bacteremia, cellulitis, and pyoderma gangrenosum-like ulcers, particularly in immunocompromised individuals such as those with X-linked agammaglobulinemia (XLA). We present a case of a 21-year-old male with XLA who presented with painful, recurrent, firm, indurated cutaneous plaques on the upper and lower extremities, initially suspected to have eosinophilic fasciitis. Diagnosis of NHPH bacteremia was confirmed using both 16S rRNA sequencing and the Karius test, a plasma-based next-generation sequencing platform that detects microbial cell-free DNA, and symptoms resolved after successful treatment of the organism. This case raises awareness for NHPH-induced fasciitis in the differential diagnosis of painful, recurrent atypical, indurated plaques in patients with XLA.