Hookworm presenting as acute febrile illness and surgical abdomen

Abstract

Hookworm is estimated to infect about 500 million people worldwide. It is usually associated with diarrhoea, abdominal pain and iron deficiency anaemia, but diagnosis can be missed because it sometimes presents unusually or mimics other diseases. We present in this report the case of an 18-year-old asthmatic medical student who was referred to a general surgeon on account of abdominal pain of 8 days duration. His problem started initially with fever, chills and rigor which was managed as malaria but no improvement. The diagnosis shifted from enteric fever to peptic ulcer disease, and his worsening condition was later reviewed as acute abdomen. Abdominal X-ray and ultrasound were normal. Stool microscopy showed numerous ova of hookworm. He was then treated with albendazole leading to full recovery on subsequent follow up. Hookworm disease can mimic a lot of other clinical conditions. A careful review of literature is a reminder that the clinical presentation of hookworm can be diverse and misleading. The current report emphasizes the fact that hookworm should always be considered a possible differential in endemic regions when clinicians are confronted with acute non-malaria febrile illnesses or cases of acute surgical abdomen.

Keywords: acute abdomen, fever, hookworm.