Washed microbiota transplantation cured a patient with immune-mediated enteropathy induced by cryptosporidium infection

Cryptosporidium infection is a worldwide disease caused by intracellular protozoan parasite Cryptosporidium, which can disrupt gut epithelial barrier and contribute to mild or severe diarrhea. Emerging evidence demonstrates that fecal microbiota transplantation (FMT) is an effective strategy for microbiota-related diseases by reconstructing gut microbiota. The new methodology of FMT depending on automatic facilities and washing processes was coined as washed microbiota transplantation (WMT). Transendoscopic enteral tubing (TET) through mid-gut is a novel and safe way for WMTs and enteral nutrition. We report a patient with immune-mediated enteropathy (IME) induced by Cryptosporidium infection, presenting with severe diarrhea, malnutrition and electrolyte disorders. Endoscopy showed diffuse inflammatory polyps in the stomach, duodenum and colon. We adopted the step-up WMT strategy, which here refers to multiple WMTs in combination with enteral nutrition and thalidomide. The patient remained asymptomatic and gastrointestinal polyps gradually decreased among three years of follow-up. This case report highlights that step-up WMT strategy may be an alternative therapy for immune-mediated diseases resistant to standard treatment.