# Case Report: Endoscopic examination improves the diagnosis of inconspicuous helminth infections in adults in Shanghai

## TL;DR

A case in Shanghai shows that endoscopic exams can help diagnose hidden hookworm infections, which are rare in modern cities.

## Contribution

Demonstrates the utility of GI endoscopy in diagnosing atypical hookworm infections in urban adults.

## Key findings

- Endoscopy identified hookworms in the GI tract despite negative faecal tests.
- Treatment with albendazole and hematinics improved the patient's anemia.
- Hookworm disease can present atypically in urban populations with improved public health.

## Abstract

With advancements in medical care and improved public health in China, the incidence of hookworm infections has significantly decreased, particularly in first-tier cities. We report a case of severe microcytic hypochromic anaemia caused by hookworm disease. The patient received multiple blood transfusions for unexplained anaemia, with negative faecal smear results. GI endoscopic examination revealed hookworms in the pyloric ring, antrum, and duodenum, which were removed using biopsy forceps. Morphological analysis identified the worms as Ancylostoma duodenale. The patient was treated with a single dose of 400 mg albendazole and hematinics. Follow-up haemoglobin testing 3 months later showed an improvement to 126 g/L (115–150 g/L). This case highlights the importance of GI endoscopy diagnostics in identifying a typical presentations of hookworm disease, particularly in first-tier cities. Timely and accurate diagnosis of hookworm infections is essential for preventing long-term health consequences and reducing associated healthcare costs.