A 60-year-old farmer in South Asia was diagnosed with severe iron deficiency anemia and duodenal ascariasis after presenting with extreme fatigue and physical nail deformities.
Clinical Presentation and Initial Findings
The patient arrived at the clinic reporting one month of worsening exertional dyspnea, generalized weakness, and significant weight loss. Physical examinations confirmed pallor and koilonychia, a condition where the nails become thin and concave, often serving as a clinical indicator of chronic iron deficiency.
Laboratory tests revealed a microcytic hypochromic anemia, with serum ferritin levels measured at a critically low 1.92 ng/mL. Because the patient was an elderly male, clinicians performed an upper gastrointestinal endoscopy to rule out potential malignancy or chronic bleeding.
Endoscopic Discovery of Duodenal Ascariasis
During the endoscopic procedure, medical staff identified multiple live, cylindrical Ascaris lumbricoides worms within the duodenum.
The endoscopy also revealed antral erosions, though researchers cautioned that these findings, combined with the parasitic infection, represent an associated condition rather than definitive proof that the worms were the sole cause of the severe anemia.
Medical Treatment Restores Patient Iron Levels
The patient’s recovery was managed through a multi-pronged approach. He received four units of packed red blood cells to stabilize his immediate condition, alongside a course of oral albendazole to eliminate the parasitic infection. For long-term recovery, the medical team prescribed a combination of carbonyl iron, folic acid, and zinc.
At a three-month follow-up, the patient’s hemoglobin had risen to 14.8 g/dL, and his serum ferritin levels had increased to 95.1 ng/mL. The characteristic spoon-shaped nails had also resolved, suggesting a successful correction of the underlying iron deficiency.
Diagnostic Considerations for Parasitic Anemia
Medical professionals emphasize that while endoscopy was effective in this specific case, it is not a first-line diagnostic tool for identifying parasitic infections. Stool microscopy remains the standard diagnostic test for detecting helminth ova or larvae in endemic regions.
The case highlights the necessity of a broad diagnostic approach when evaluating elderly patients for severe anemia. Clinicians must balance the search for gastrointestinal malignancy with the assessment of environmental factors, such as poor sanitation and occupational exposure to contaminated soil, which can lead to parasitic infestations.
Clinical Reasons for Endoscopy and Anemia Diagnosis
Why was an endoscopy performed instead of a stool test?
The patient was an elderly male presenting with severe iron deficiency anemia and no clear history of dietary restrictions. In such cases, clinical protocols prioritize ruling out life-threatening conditions like gastrointestinal malignancy or ulceration, making endoscopy a necessary part of the evaluation.
Can koilonychia be caused by things other than iron deficiency? It is considered a clinical indicator that requires further investigation rather than a standalone diagnosis.
Was the parasitic infection the only cause of the anemia?
No, a definitive causal relationship cannot be established from this single case. The patient’s recovery followed a combination of deworming, blood transfusions, and iron supplementation, meaning the individual contribution of each treatment to the clinical improvement remains uncertain.
Worth a look