University of Kansas Medical Center Kansas City, KS, United States
Kyle Yuquimpo, DO1, Sophia Hitchock, MD1, Christopher Koehn, MD2, Brent Harbaugh, DO1, Zelina Ardasenov, MD, PhD1, John Bonino, MD1 1University of Kansas Medical Center, Kansas City, KS; 2University of Kansas School of Medicine, Fairway, KS
Introduction: Iron deficiency anemia (IDA) is a common medical problem encountered in primary care clinics. Etiologies of IDA are varied, but initial workup usually includes investigating potential sources of chronic occult bleeding. We present a unique case of a middle-aged male presenting with fatigue, IDA, and overt hematochezia secondary to parasitic infection.
Case Description/Methods: A 37-year-old Thai male presented to clinic with chest pain, fatigue, and anemia. He also reported episodes of self-limited hematochezia, over the last year prior to presentation. Physical exam revealed conjunctival pallor. Lab work revealed a hemoglobin of 6.0 with an MCV < 50.0. Iron studies revealed a ferritin of two. Endoscopic evaluation was performed. EGD with duodenal biopsies was unremarkable. During colonoscopy, multiple, flat ribbon-like structures were found in the colon (Panels A, B). Specimens were collected by biopsy forceps for microscopic analysis revealing mature Taenia proglottids and eggs (C). The patient reported consuming raw beef and pork before immigrating to the US. He also noted egg-like structures in his stool for the prior 15 years. He was treated with praziquantel. During a follow-up clinic visit, his anemia resolved and stool studies confirmed taenia eradication.
Discussion: We present a case of severe IDA due to intestinal Taenia parasites discovered on colonoscopy. Common symptoms of intestinal Taeniasis are generally mild and can include abdominal pain, anorexia, and weight loss. Visualization of the of proglottids in the stool is frequently reported by patients.
Anemia secondary to infection with taeniasis is very rare in the U.S. The patient in our case, was even more unusual as he had additionally reported a history of recurrent overt hematochezia.
Our case identified proglottids, sexually mature tapeworm segments, during his colonoscopy. Proglottids pass through the anus and release eggs that are then ingested by cattle and pigs. Human infection occurs upon consumption of meat from these animals. The current gold standard for diagnosis is stool microscopy. In the rare reported cases of taeniasis-induced IDA in the US, visualization of the tapeworm occurred via small bowel video capsule endoscopy. Our case presents a unique and rare instance of the identification proglottids during colonoscopy. Clinicians should consider taenia infection in patients presenting from countries where this infection is endemic, and present with iron deficiency anemia (with or without overt bleeding).
Figure: Endoscopic images of Taenia proglottids in the colon (A,B). H&E images of sections of Taenia revealing proglottid histology and numerous eggs (C).
Disclosures: Kyle Yuquimpo indicated no relevant financial relationships. Sophia Hitchock indicated no relevant financial relationships. Christopher Koehn indicated no relevant financial relationships. Brent Harbaugh indicated no relevant financial relationships. Zelina Ardasenov indicated no relevant financial relationships. John Bonino indicated no relevant financial relationships.
Kyle Yuquimpo, DO1, Sophia Hitchock, MD1, Christopher Koehn, MD2, Brent Harbaugh, DO1, Zelina Ardasenov, MD, PhD1, John Bonino, MD1. P0473 - A Rare Case of Intestinal Taeniasis Presenting With Hematochezia and Iron Deficiency, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.