Introduction: Iron deficiency anemia (IDA) is a common medical condition which has numerous possible causes. It is due to reduced dietary intake, blood loss or reduced absorption. Reduced absorption of iron is an uncommon cause of iron deficiency, especially in healthy non-vegetarian individuals and in resource-rich countries. We present an uncommon cause of IDA secondary to an Ascaris Lumbricoides infection in the western hemisphere.
Case Description/Methods: 65-year-old female with medical history of hypothyroidism, Non-Insulin dependent diabetes and diverticulitis presented to the gastroenterology office for evaluation of newly diagnosed iron deficiency anemia. On presentation she revealed she has been constipated with intermittent bloating. She had also seen some blood in her stool while straining to defecate. Colonoscopy was performed and revealed minor diverticulosis of the sigmoid colon. She underwent subsequent esophagogastroduodenoscopy which revealed esophageal erosion at gastro esophageal junction, severe gastritis with no duodenitis. There was no source of bleed identified so she underwent a capsule endoscopy. She was found to have a distal ileum large worm believed to be Ascaris lumbricoides. She was treated with a one-time dose of Mebendazole.
Discussion: Ascaris Lumbricoides is known as a “giant roundworm” for its size. An adult worm can grow up to 35cm. Approximately 200,000 eggs are laid per day and passed via feces. Unfertilized eggs develop into infective embryonated eggs (stage 2 larva) in warm, moist soil. Defecation outside in developing countries is the major risk factor, it is uncommonly seen in the western populations due to modern sanitation. Humans are infected by ingestion of food or water contaminated by infective eggs. After ingestion, larvae hatch in the intestine, enter the bloodstream and travel to the lungs. The larvae travel up from the alveoli to the main airway, pharynx and are swallowed. The worms live within the lumen of the smallintes tine and obtain nutrition from ingested food. Most infections by ascaris lumbricoides are asymptomatic. Malnutrition can be seen in patients with heavy worm burden, as the organism shares nutrition with the host. In patients with IDA and non-specific abdominal symptoms evaluation for ascariasis should be considered in the setting of applicable exposure or if all other common causes are ruled out.
Figure: Capsule endoscopy video stream of the large worm visualized throughout the gastrointestinal tract.
Disclosures: Polina Gaisinskaya indicated no relevant financial relationships. Yonatan Ghiwot indicated no relevant financial relationships. Arun Sunny indicated no relevant financial relationships. Eric Abkian indicated no relevant financial relationships.
Polina Gaisinskaya, MD1, Yonatan Ghiwot, MD1, Arun Sunny, MD2, Eric Abkian, MD2. P1498 - Ascaris Lumbricoides Diagnosed During Evaluation of Iron Deficiency Anemia by Capsule Endoscopy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.