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Hookworm infection of sigmoid colon masquerading as graft-versus-host disease in an allogeneic stem cell transplant recipient after donor lymphocyte infusion for refractory acute promyelocytic leukemia

Bone Marrow Transplantation volume 37, pages 785–786 (2006)Cite this article

Hookworm infection affects an estimated 1 billion people in the world. It is endemic worldwide, including much of Africa, Asia, South America and the southeastern United States. Primary infection involves penetration of the skin by soil dwelling infectious filariform larvae. Presence of the worm within the skin may lead to pruritus and rash persisting for several weeks. Hookworms have a complex life cycle that begins and ends in the small intestine. The worms typically are restricted to the small intestine and usually cause mild diarrhea. We report here an unusual presentation of a hookworm infection in an allogeneic stem cell transplant recipient.

Helminthic infections of the gastrointestinal tract have been shown to cause morbidity and mortality in stem cell transplant setting. Infections of trematode worms, Clonorchiasis and Schistosomiasis, have been shown to be predisposing factors for veno-occlusive disease of the liver after allogeneic transplantation.1, 2 Infections of nematode roundworms, Strongyloidiasis and Ascariasis, have been reported to cause infections in autologous and allogeneic transplant settings.3, 4, 5, 6 Strongyloidiasis may be fatal after stem cell transplantation.3, 4 However, there have been no reports of hookworm infection after stem cell transplantation despite worldwide endemia. To our knowledge, this case is the first report of hookworm infection of nematode family, ancylostomiasis, occurring in an allogeneic stem cell transplant recipient. Hookworms typically infect the small intestine; therefore, this case is also one of the very rare examples of hookworm infection on human colonic mucosa.7 Its clinical presentation with skin rash and mild diarrhea conforms to the GVHD of skin and bowel. Although the skin and colon biopsies were reported as GVHD in our case, we believe that hookworm infection was the primary event that might have triggered a possible mild graft-versus-host reaction, as the patient's symptoms disappeared after treatment with mebendazole and he was given no systemic immunosuppression. Our experience is consistent with a report showing the protozoal infection of gastrointestinal tract (blastocystosis) coexisting with GVHD of bowel and that diarrhea ameliorated with appropriate treatment of infection.8 We conclude that hookworm infection occurs in recipients of allogeneic transplantation and may clinically mimic graft-versus-host disease.

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  1. Department of Blood and Marrow Transplantation, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    E Ozdemir & J J Molldrem

  2. Hematopoietic Stem Cell Transplantation Unit, Section of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey

    E Ozdemir

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  1. E Ozdemir
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Ozdemir, E., Molldrem, J. Hookworm infection of sigmoid colon masquerading as graft-versus-host disease in an allogeneic stem cell transplant recipient after donor lymphocyte infusion for refractory acute promyelocytic leukemia. Bone Marrow Transplant 37, 785–786 (2006). https://doi.org/10.1038/sj.bmt.1705309

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