Worms in the bowel: A cause of iron-deficiency anemia

A 74-year-old Asian farmer presented with nausea and atigue. Laboratory tests showed microcytic anaemia (MCV, 76 fL; ormal =80–100 fL; haemoglobin, 7.6 g/dL; normal =12–16g/dL), normal white blood cell count (5460/ L; normal =4000– 2,000/ L), a high eosinophil percentage (7%; normal =0–0.4%) and ypoferritinaemia (ferritin, 10.1ng/mL; normal =16–300ng/mL). faecal occult blood test was positive. Upper gastrointestinal ndoscopy revealed normal mucosa and no ulceration in the stomch. In the second and third part of the duodenum, many small urved worms were observed (Fig. 1). Microscopic examination of aeces revealed thin-shelled hookworm eggs containing 6–8 cells ach (Fig. 2, magnification=400×). The patient was treated with ralmebendazole (100mg twice daily) for 3 days, which eradicated he worms. Hookworm infections are caused by soil-dwelling nemaodes, mainly Necator americanus and Ancylostoma duodenale 1]. The adult parasites attach to the mucosa and submucosa f the small intestine, resulting in intestinal blood loss [1]. ron-deficiency anaemia and hypoalbuminaemia develop when ron lost through bleeding exceeds the iron intake and reserves f the host [1]. Mebendazole and albendazole are the drugs ost commonly used for the treatment of hookworm infecions. In conclusion, hookworm infection should be considered n the differential diagnosis of patients with iron-deficiency naemia.