Hookworm-induced refractory gastric ulcer (with video)

A 63-year-old man presented to the gastroenterology clinic with a 1-month history of upper middle abdominal pain. Laboratory studies revealed an eosinophil count of 660/mm3 (reference range, 20-520/mm3) and elevated immunoglobulin E (IgE). EGD showed a gastric ulcer (A) with Helicobacter pylori infection. Histopathologic examination revealed chronic nonatrophic gastritis with eosinophil infiltration in the lamina propria (B; 30-40/high power field [HPF]; partially marked by black arrows; H&E, orig. mag. ×400). Antiulcer treatment including anti-H pylori therapy was initiated. A review endoscopy 1 month later showed that the gastric ulcer had improved but still had eosinophil infiltration (about 50/HPF in dense area). Prednisone was prescribed. At a 4-month follow-up visit, endoscopy revealed another gastric ulcer.