# Helicobacter heilmannii Infection With Concurrent Gastric Cancer: A Case Report

## TL;DR

A rare case of gastric cancer linked to Helicobacter heilmannii infection is reported, highlighting its distinct features and potential role in cancer development.

## Contribution

This case report adds to the understanding of H. heilmannii's role in gastric cancer and its unique clinical and histological features.

## Key findings

- H. heilmannii infection was confirmed in a patient with multiple early gastric cancers and negative H. pylori test.
- Cobblestone-like gastritis and lymphocyte-dominant infiltration were observed, distinct from H. pylori-associated gastritis.
- Endoscopic submucosal dissection achieved curative resection without recurrence in this case.

## Abstract

Helicobacter heilmannii (H. heilmannii), a zoonotic pathogen, is increasingly recognized as a cause of gastritis and a potential risk factor for gastric cancer, despite its rarity. Here, we report a case of multiple synchronous early gastric cancers in a female patient in her 40s with H. heilmannii-associated gastritis. She underwent an esophagogastroduodenoscopy (EGD) for the evaluation of gastric discomfort. Endoscopy revealed cobblestone-like gastritis. Histological examination confirmed a signet ring cell carcinoma. Helicobacter pylori (H. pylori) antibody test was negative, and spiral-shaped bacteria were detected by Giemsa staining and real-time polymerase chain reaction (PCR), confirming H. heilmannii infection. Endoscopic submucosal dissection achieved curative resection without recurrence. Helicobacter heilmannii-induced gastritis presents distinct features, including a cobblestone-like appearance and lymphocyte-dominant infiltration, differing from H. pylori-associated gastritis. Chronic inflammation and immune modulation caused by H. heilmannii infection may contribute to carcinogenesis. Considering the diagnostic challenges and zoonotic transmission risks, enhanced awareness of H. heilmannii-associated gastric cancer is essential. This case highlights the importance of identifying H. heilmannii in H. pylori-negative gastritis and its potential role in gastric carcinogenesis. Further research is required to elucidate the pathogenic mechanisms and establish effective management protocols.