Case Report
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World J Gastroenterol. Mar 28, 2014; 20(12): 3376-3382
Published online Mar 28, 2014. doi: 10.3748/wjg.v20.i12.3376
Helicobacter heilmannii sensu stricto-related gastric ulcers: A case report
Takehisa Matsumoto, Masatomo Kawakubo, Taiji Akamatsu, Naohiko Koide, Naoko Ogiwara, Seiko Kubota, Mitsutoshi Sugano, Yoshiyuki Kawakami, Tsutomu Katsuyama, Hiroyoshi Ota
Takehisa Matsumoto, Masatomo Kawakubo, Naoko Ogiwara, Seiko Kubota, Mitsutoshi Sugano, Tsutomu Katsuyama, Departments of Laboratory Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto 390-8621, Japan
Tsutomu Katsuyama, Maruko Central Hospital, 1771-1 Maruko, Ueda 386-0405, Japan
Taiji Akamatsu, Endoscopy Center, Suzaka Hospital, Nagano Prefectural Hospital Organization, 1332 Suzaka, Suzaka, Nagano 382-0091, Japan
Naohiko Koide, Department of Surgery, Nagano Prefectural Kiso Hospital, Kiso-Fukushima 397-0001, Japan
Yoshiyuki Kawakami, Hiroyoshi Ota, Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
Author contributions: Matsumoto T designed and conducted research, wrote the manuscript and had primary responsibility for final content; Kawakubo M, Kubota S and Sugano M performed the research; Ogiwara N performed transmission electron microscopy analysis; Akamatsu T and Koide N performed endoscopic procedures and treatment; Kawakami Y proofread and revised the manuscript; Katsuyama T made the pathological diagnosis, and Ota H designed research, made the pathological diagnosis and wrote the manuscript.
Supported by A Grant-in-Aid for Scientific Research C-20590564 from the Ministry of Education, Culture, Sports, Science and Technology, Japan, to Ota H
Correspondence to: Takehisa Matsumoto, PhD, Departments of Laboratory Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto 390-8621, Japan. ggatcc@shinshu-u.ac.jp
Telephone: +81-263-373493 Fax: +81-263-373492
Received: November 27, 2013
Revised: January 10, 2014
Accepted: January 20, 2014
Published online: March 28, 2014
Processing time: 119 Days and 15.7 Hours
Abstract

A spiral bacterium (SH9), morphologically different from Helicobacter pylori (H. pylori), was found in a 62-year-old woman’s gastric mucosa. Gastroscopic examination revealed multiple gastric ulcers near the pyloric ring; mapping gastric biopsy showed mild mononuclear infiltration with large lymphoid follicles in the antrum, without corpus atrophy. Urea breath test and H. pylori culture were negative, but Giemsa staining of biopsies revealed tightly coiled bacteria that immunostained with anti-H. pylori antibody. Sequencing of SH9 16S rRNA and the partial urease A and B subunit genes showed that the former sequence had highest similarity (99%; 1302/1315 bp) to Helicobacter heilmannii (H. heilmannii) sensu stricto (H. heilmannii s.s.) BC1 obtained from a bobcat, while the latter sequence confirmed highest similarity (98.3%; 1467/1493 bp) to H. heilmannii s.s. HU2 obtained from a human. The patient was diagnosed with multiple gastric ulcers associated with H. heilmannii s.s. infection. After triple therapy (amoxicillin, clarithromycin, and lansoprazole) with regimen for eradicating H. pylori, gastroscopy showed ulcer improvement and no H. heilmannii s.s. upon biopsy.

Keywords: Helicobacter heilmannii sensu stricto, “Helicobacter heilmannii” type 2, Gastric ulcers, Urease gene, Non-Helicobacter pylori helicobacters

Core tip: Herein we report a case of Helicobacter heilmannii sensu stricto (H. heilmannii s.s.)-related gastric ulcers. The organism was identified as H. heilmannii s.s which is a recently identified species of the former “H. heilmannii” type 2 group by transmission electron microscopy, 16S rRNA gene and the partial urease gene sequences. After triple therapy with regimen for eradicating Helicobacter pylori, gastroscopy showed ulcer improvement and no H. heilmannii s.s. upon biopsy.