Severe Iron Deficiency Anemia Linked to Duodenal Ascariasis in Elderly Male

Profound iron deficiency anemia can occasionally stem from parasitic infections such as hookworm or ascariasis rather than typical gastrointestinal bleeding or dietary factors. Two distinct medical case reports outline how clinicians identified parasitic causes in older male patients through diagnostic evaluations that included upper gastrointestinal endoscopy.

Physicians investigating severe drops in hemoglobin in older adults typically look for gastrointestinal bleeding or malignancies. Parasitic infestations can instead trigger profound iron depletion in vulnerable populations with specific environmental exposures.

Doctors Diagnose Hookworm in Trinidad and Tobago Patient

A 61-year-old male patient arrived at the emergency department following a syncopal episode and a fall as reported in clinical literature from Trinidad and Tobago. Initial blood tests revealed a remarkably low hemoglobin level of 2.5 g/dL alongside a serum ferritin reading of 1.96 ng/ml, confirming profound microcytic anemia.

A contrast-enhanced computed tomography scan of the abdomen and pelvis ruled out acute internal bleeding but showed marked thickening of the gastric fundus and body, initially raising suspicions of a gastric malignancy. Further blood work indicated an elevated eosinophil percentage.

Following hemodynamic stabilization and packed red blood cell transfusions, the patient underwent an esophagogastroduodenoscopy.

Endoscopic evaluation identified short-segment Barrett’s esophagus and multiple motile nematodes attached directly to the duodenal mucosa. Given the endemic exposure, elevated eosinophils, and severe anemia, clinicians considered the presentation morphologically suggestive of a hookworm infection. Dietary and social histories confirmed environmental risk factors, including habitual barefoot outdoor exposure and the regular consumption of wild meat. Stool microscopy returned negative results, and histopathology found no evidence of malignancy or parasites. Medical teams treated the patient with albendazole and proton pump inhibitor therapy, resulting in clinical recovery and sustained hematologic stability.

Clinicians Treat Farmer for Duodenal Ascariasis

A 60-year-old male farmer from South Asia sought medical attention for exertional dyspnea, generalized weakness, pallor, weight loss, and gradual nail changes according to findings detailed by Cureus. Physical examination revealed that the patient exhibited spoon-shaped nails, known clinically as koilonychia.

Laboratory investigations confirmed severe microcytic hypochromic anemia, marked by a hemoglobin level of 4.2 g/dL, a serum ferritin level of 1.92 ng/mL, low serum iron, and an elevated total iron-binding capacity. To investigate the root cause of the deficiency, physicians performed an upper gastrointestinal endoscopy, which uncovered multiple live Ascaris lumbricoides worms residing in the duodenum.

Parasitic infections can affect vulnerable populations with specific environmental exposures.

The patient received treatment consisting of albendazole, red cell concentrate transfusions based on his clinical condition, and oral iron supplementation. At a three-month follow-up evaluation, he showed substantial clinical, hematological, and biochemical recovery, alongside visible improvement in his nail structure.

Evaluating Diagnostic Implications for Severe Anemia

Both cases demonstrate the diagnostic challenges involved when common nutritional deficiencies or malignant mimics mask underlying infectious etiologies. Hookworms actively ingest host blood and excreting anticoagulants to cause high-volume occult bleeding, while ascariasis contributes to anemia through mechanisms such as decreased nutritional intake, impaired absorption, and nutrient competition.

Standard diagnostic workups traditionally rely on stool microscopy to identify helminth ova, but low parasite counts or intermittent egg-shedding cycles can frequently compromise fecal test sensitivity. Direct endoscopic visualization inside the proximal small bowel serves as a valuable diagnostic tool during evaluations for unexplained severe anemia, even though clinicians emphasize that endoscopy functions as part of an assessment rather than a first-line test for parasites alone.

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