Chronic norovirus infection in a patient with Good’s syndrome resolved after fecal microbiota transplantion and improved nutrional status

Norovirus may cause chronic infection in immunocompromised patients. Both B-cell and T-cell responses are important for viral clearance. Currently, there is no established treatment but various substances have been evaluated, yielding mixedresults. This report presents a patient diagnosed with Good's syndrome, which includes hypogammaglobulinemia, who suffered from a chronic norovirus infection for several years. Nitazoxanide treatment was administered for 4 weeks due to ongoing diarrhoea and declining nutritional status; however, symptoms did not improve. Subsequently, fecal microbiota transplantation (FMT) was assessed using a single dose of cultured human microbiota. This procedure improved symptoms but did not eliminate the infection. The patient's symptoms returned after 6 months, at which time two FMT doses were administered, resulting in symptom amelioration. Three months later, a more pronounced relapse led to severe nutritional decline, most notably manifesting as overt vitamin A deficiency accompanied by visual impairment. Again, the patient underwent two administrations of FMT; however, relapse occurred shortly thereafter. Parenteral nutrition was then initiated after consultation with the hospital's clinical nutrition team. Symptoms promptly improved, with a decrease in diarrhoea and an increase in weight. A stool sample collected 2.5 months following the final FMT combined with parental nutrition demonstrated no detectable norovirus, and the patient has remained in stable health for 3 years. We believe that the patient's chronic norovirus infection was resolved through the combination of enhanced nutritional status and FMT.