Anemia in a 17-Year-Old Hispanic Girl

Abstract

A 17-year-old Hispanic girl was referred with a history of persistent anemia suggestive of iron deficiency, refractory to oral and intravenous iron therapy. She did not have a personal history of abnormal menstrual periods, gastrointestinal bleeding, significant lead exposure, or respiratory symptoms. There was no significant family history. Physical examination revealed 2/6 systolic murmur without enlarged liver or spleen. Laboratory data revealed a hemoglobin level of 7.4, ferritin level of 2.1, reticulocyte count of 2.6, iron level of 9, transferrin level of 284, total iron binding capacity of 423, and transferrin saturation of 2, with normal hemoglobin electrophoresis. Stools were positive for occult blood. Endoscopy was performed and was visually normal. Biopsy specimens were taken, which were normal. Colonoscopy was performed, revealing 4 white flat masses ranging in size from 1.2 × 0.4 × 0.2 cm to 1.6 × 0.5 × 0.1 cm (Figure A) that were in the lumen of the descending and sigmoid colon and not adherent to the surface. These findings were consistent with gravid proglottid of Taenia spp or tapeworm. Taenia is acquired most commonly in human beings by consuming raw or undercooked pork.1World Health Organizationhttp://www.who.int/zoonoses/neglected_zoonotic_diseasesGoogle Scholar Many developing countries such as Latin America, Africa, and Asia continue to have problems with pork tapeworm infections.1World Health Organizationhttp://www.who.int/zoonoses/neglected_zoonotic_diseasesGoogle Scholar, 2Willms K. Morphology and biochemistry of the pork tapeworm, Taenia solium.Curr Top Med Chem. 2008; 8: 375-382Crossref PubMed Scopus (17) Google Scholar Pigs initially are infected with cysticerci after eating human feces containing Taenia eggs. When a human ingests raw or undercooked pork they consume cysticerci. These larva then evaginate in the stomach and duodenum and attach to the intestinal wall. Over time they develop into tapeworms.2Willms K. Morphology and biochemistry of the pork tapeworm, Taenia solium.Curr Top Med Chem. 2008; 8: 375-382Crossref PubMed Scopus (17) Google Scholar An intact tapeworm was encountered in the cecum/ascending colon extending through the ileocecal valve (Figure B). Upon further questioning, the patient stated that she had consumed pickled pork in Mexico before developing symptoms of anemia. Microscopically, the worm portion showed apparent genital or gynecophoral pore, and eggs. The trichrome stain showed eggs. The periodic acid–Schiff stain showed pores on the surface and eggs within apparent uterine type cavities. Tissue and active inflammation were not identified on deeper H&E levels. The patient was treated with praziquantel 600 mg orally × 1 dose. Hemoglobin levels were monitored and normalized after treatment. The patient had no further iron-deficiency anemia after eradication of Taenia.