Hookworm infestation in the biliary tract: a case report

BACKGROUND: Hookworms are parasitic nematodes that primarily infect humans in impoverished communities. They attach to the intestines to feed on blood, which results in anemia and other health complications. While parasitic infections of the biliary tract can occur and lead to significant issues such as cholangitis, pancreatitis, and biliary obstruction, hookworms are not documented to be associated with these biliary infestations. CASE PRESENTATION: A 53-year-old female Tibeto-Burman ethnicity following Buddhism, with a significant smoking history and no alcohol consumption presented to Tribhuvan University Teaching Hospital with an 8-month history of progressively worsening abdominal pain, fever, decreased appetite, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant and positive Murphy's sign, while laboratory tests indicated elevated liver enzymes, high eosinophils count, prolonged prothrombin time, and signs of inflammation. Imaging studies revealed cholelithiasis and choledocholithiasis, along with the unusual finding of a live worm in the biliary tract during an endoscopic retrograde cholangiopancreatography (ERCP), which was later confirmed as a hookworm infestation. The patient was treated with a comprehensive antiparasitic regimen (Metronidazole 400 mg), along with pain management (Tramadol hydrochloride, and Acetaminophen) and gastrointestinal support (Cremaffin syrup). After a week, she reported significant improvement and was discharged, with subsequent follow-up showing resolution of symptoms along with marked improvement in liver function tests and normal eosinophil count. CONCLUSION: This instance highlights the fact that hookworms can cause obstructive illness even though they are rare in the biliary system. It emphasizes the importance of timely endoscopic examination and focused antiparasitic therapy, as well as the necessity of taking into account atypical parasitic causes when symptoms cannot be adequately explained by usual biliary disorders.