Severe Iron Deficiency Anemia With Koilonychia and Endoscopically Detected Duodenal Ascariasis in an Elderly Male: A Case Report

Iron deficiency anemia is a common nutritional and clinical condition that can arise from chronic blood loss, insufficient dietary intake, impaired absorption, or parasitic infection, especially in areas where such infections are endemic.In elderly male patients, a thorough evaluation is necessary to rule out gastrointestinal bleeding and malignancy.A 60-year-old male farmer experienced exertional dyspnea, generalized weakness, pallor, weight loss, and gradual changes in his nails.Physical examination revealed the characteristic spoon-shaped nails of koilonychia.Laboratory tests confirmed severe microcytic hypochromic anemia with significantly depleted iron stores, as indicated by a hemoglobin level of 4.2 g/dL, serum ferritin of 1.92 ng/mL, low serum iron, and elevated total iron-binding capacity.Upper gastrointestinal endoscopy, performed to investigate the severe iron deficiency anemia, revealed multiple live Ascaris lumbricoides worms in the duodenum, consistent with duodenal ascariasis.The patient was treated with albendazole, red cell concentrate transfusion based on his clinical condition, and oral iron supplementation.At the three-month follow-up, he demonstrated marked clinical, hematological, and biochemical improvement, including improvement of koilonychia.This case underscores that parasitic infestation can coexist with or contribute to severe iron deficiency anemia in endemic areas.Stool microscopy remains an important standard diagnostic test, whereas endoscopy should be viewed as part of a broader evaluation for unexplained severe anemia, not as a first-line test for ascariasis.