Upper gastrointestinal bleeding from hookworm infestation: Rare case report

Hookworm disease is one of the most widely distributed parasitic infections in the world. It is endemic in Europe, America, Africa, and Asia. It is caused by the nematode species Ancylostoma duodenale and Necator americanus. Adult worms typically inhabit the small intestine and are rarely found in the stomach. Hookworm infestation may be asymptomatic or present with chronic anemia due to occult gastrointestinal blood loss, depending on the worm burden. Overt upper gastrointestinal bleeding (UGIB) is an exceedingly rare presentation. This case describes an 87-year-old patient with recurrent episodes of UGIB, melena, generalized body swelling, and anemia-related symptoms. On physical examination, the patient appeared chronically ill, with tachycardia, conjunctival pallor, an S3 gallop, and abdominal distension with a positive fluid thrill and shifting dullness. Microscopic examination of the stool revealed hookworm ova. Complete blood count showed severe anemia with thrombocytopenia, and a peripheral blood smear demonstrated microcytosis and hypochromia. Low serum albumin level was also noted. Esophagogastroduodenoscopy revealed numerous hookworms in the stomach and duodenum, along with active bleeding sites. The patient was diagnosed with UGIB secondary to hookworm infestation. Management included blood transfusions, high-dose omeprazole, antiparasitic therapy with albendazole, and iron supplementation with ferrous sulfate. Gradual clinical improvement was observed, with resolution of bleeding and stabilization of hemoglobin levels. This case highlights the diagnostic challenges and therapeutic considerations associated with this rare manifestation.