P3035 - A Wiggly Problem Causing Persistent Iron Deficiency Anemia

Ellie Soheili, MD¹, Faris H. Pacha, DO¹, Natalia Martin, DO¹, Emmanuel A. McDonald, DO¹, Karthik Mohan, DO^2
1Larkin Community Hospital, South Miami, FL; ²Larkin Community Hospital, Hialeah, FL

Introduction: E. vermicularis occurs worldwide, with infections occurring most frequently in children and in crowded conditions or institutionalized facilities. Transmission occurs in people who are living in closed contact with contaminated items or even during sexual contact. The most typical symptom is perianal pruritus, especially at night, which may lead to excoriations and bacterial superinfection. Occasionally, invasion of the female genital tract with vulvovaginitis and pelvic or peritoneal granulomas can occur. Other symptoms include, teeth grinding, enuresia, insomnia, anorexia, irritability, and abdominal pain. Very rare instances of eosinophilic colitis associated with E. vermicularis larvae have been reported. Diagnosis usually done by a "tape test" and/or by visualizing pinworms in the stools or on the skin near the anus or in the vagina; however, in rare cases such as patient FT, it requires further investigation by endoscopy.

Case Description/Methods: A 74 year old male patient who presented for evaluation of Hgb 10.4 and iron deficiency anemia. Patient denied hemoptysis, hematemesis, hematochezia and melena. However, patient complained of abdominal discomfort and bloating for the last 3 weeks. He stated he did not experience nausea, vomiting, no change in bowel habits, and weight loss. Patient did not report a history of bowel obstruction or small bowel disease, recent travel, or sick contacts. He was subsequently referred for bidirectional endoscopy which showed no evidence of active GI bleed, colonoscopy was significant for hemorrhoids and diverticulosis of the large intestine, and EGD demonstrated mild antral gastritis and a 1cm hiatal hernia. Further investigation by capsule endoscopy was performed which demonstrated an usual and embedded Enterobious vermicularis worm in the small intestine.

Discussion: This case was chosen because the pinworm was an incidental finding upon evaluation of iron deficiency anemia in an older patient with no typical symptoms of pinworm infection. Enterobiasis can be diagnosed via examination of cellophane tape for eggs after pressing to the perianal skin is not necessary as worms and eggs are not passed in stool. For treatment of enterobiasis, Albendazole or Mebendazole are suggested. Simultaneous treatment of the entire household is warranted, given high transmission rates among families. In our case patient was treated with Albendazole and his anemia was improved with Iron supplementation in future office visit.


Figure: Figure 1. Pill Endoscopy demonstrating Enterobius vermicularis in the small bowel causing the patient's iDA. Prompt treatment lead to the resolution.


Disclosures:
Ellie Soheili indicated no relevant financial relationships.
Faris Pacha indicated no relevant financial relationships.
Natalia Martin indicated no relevant financial relationships.
Emmanuel McDonald indicated no relevant financial relationships.
Karthik Mohan indicated no relevant financial relationships.


Ellie Soheili, MD¹, Faris H. Pacha, DO¹, Natalia Martin, DO¹, Emmanuel A. McDonald, DO¹, Karthik Mohan, DO². P3035 - A Wiggly Problem Causing Persistent Iron Deficiency Anemia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.