# A Rare Presentation of Erosive Gastritis Caused by Helicobacter heilmannii Infection

## TL;DR

A rare case of erosive gastritis caused by Helicobacter heilmannii infection is reported, highlighting the importance of considering this pathogen in unexplained gastrointestinal symptoms.

## Contribution

This paper presents a novel clinical case emphasizing the underdiagnosed role of H. heilmannii in erosive gastritis.

## Key findings

- H. heilmannii was identified as the cause of erosive gastritis in a patient with a history of breast cancer.
- The patient's symptoms resolved completely after bismuth quadruple therapy.
- H. heilmannii may present with subtle histopathologic features leading to underdiagnosis.

## Abstract

Helicobacter heilmannii (H. heilmannii) is an uncommon gastric pathogen increasingly recognized for its role in gastrointestinal diseases. Unlike Helicobacter pylori (H. pylori), H. heilmannii is rarely detected and often overlooked. It is typically associated with milder pathological features, including less neutrophilic activity, reduced mononuclear infiltration, and endoscopic signs of chronic gastritis without erosions or ulcers.

We report a case of a 71-year-old female patient with a history of invasive breast carcinoma who presented with dysphagia, nausea, and dyspepsia following chemoradiotherapy. Initial endoscopy revealed esophageal strictures and erosive gastritis, with biopsies negative for H. pylori. Persistent symptoms prompted repeat endoscopic evaluation, which demonstrated H. heilmannii on histology. The patient responded well to bismuth quadruple therapy, with complete symptom resolution and eradication of the infection.

This case underscores the need to consider H. heilmannii as an uncommon but potential cause of unexplained erosive gastritis or peptic ulcer disease, given its typically milder histopathologic features, such as reduced neutrophilic and mononuclear infiltration and subtle endoscopic findings, which may contribute to underdiagnosis. Prompt recognition and treatment can lead to excellent clinical outcomes and may reduce the risk of long-term complications such as mucosa-associated lymphoid tissue (MALT) lymphoma.