Abstract
The aim of this case report is to alert physicians to the possibility that hookworm disease can lead to acute pancreatitis. Method: We report a case of hookworm infestation associated with acute pancreatitis and food intolerance. Result: The patient presented on the emergency department complaining of anorexia, asthenia, nausea, vomiting, epigastric pain and fever. Blood test showed a amylase of 512U/L and a lipase of 1902, normal levels of hepatic aminotransferases, bilirubin and alkaline phosphatase and a slight elevation of the Creactive protein. An ultrasound showed no cholelithiasis, thickening of vesicular wall or dilation of the common bile duct and the computed tomography (CT) showed a normal pancreas with no evidence of cholecystitis or peripancreatic fluid. An upper digestive endoscopy was done because of food intolerance and revealed gastric stasis and duodenal mucosa congestive, friable, with loss of the usual pleating with biopsies revealing the presence of Ancylostoma duodenale. The patient was treated with albendazole and remains asymptomatic in a 3-year follow-up. Conclusion: Hookworm infestation is usually asymptomatic. Ampulla of Vater-migrating hookworms resulting in acute pancreatitis is a very rare event.
Highlights
Hookworm infections are a common disease in tropical and subtropicals areas [1]
Hookworm infestation is usually asymptomatic and anemia is the major clinical finding of infection [3] being proportional to the number of adult worms in the gut [4]
Anthelminthic treatment of hookworm infection consists of albendazole (400 mg once on empty stomach)
Summary
Hookworm infections are a common disease in tropical and subtropicals areas [1]. Its prevalence is higher in sub-Saharan Africa, followed by Asia, Latin America, and the Caribbean. There are two major hookworm species causing human infection: Ancylostoma duodenale (in Mediterranean countries, Iran, India, Pakistan, and the Far East) and Necator americanus (in North and South America, Central Africa, Indonesia, islands of the South Pacific, and parts of India) [2]. The larvae migrate to the heart via hematogenous or lymphatic circulation, reaching the lungs through the pulmonary arteries. They move through the tracheobronchial tree by serpentine movements, secretions and cilia and reach the trachea, larynx and pharynx. Hookworm infestation is usually asymptomatic and anemia is the major clinical finding of infection [3] being proportional to the number of adult worms in the gut [4]. Anthelminthic treatment of hookworm infection consists of albendazole (400 mg once on empty stomach). Other control strategies aimed at improving water quality, sanitation and hygiene are needed [10]
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