P4124 - Trichuriasis Presenting With Severe Anemia and Melena: A Case Report

Beatriz Ximenes Braz, MSc, MD¹, Chaitra Banala, MD², William C. McGonigle, ³, Jorge R. Gonzalez, MD, MBA⁴, Rama Tarakji, MD⁵, Mahmoud Mahfouz, MD^2
1University of Miami Miller School of Medicine at Jackson Memorial Hospital, Miami, FL; ²University of Miami Miller School of Medicine, Miami, FL; ³University of Miami Miller School of Medicine, Norcross, GA; ⁴Jackson Memorial Hospital, Miami Springs, FL; ⁵Mount Sinai Medical Center, Miami, FL

Introduction: Trichuriasis is an infection caused by the whipworm Trichuris trichiura, which most commonly affects the cecum. We describe a case, with the initial presentation of infection being severe anemia and melena.

Case Description/Methods: A 50-year-old woman with no known past medical history who had recently immigrated to the United States from Central America presented to the emergency department with epigastric abdominal pain and fatigue for 7 days. She later progressed with nausea, vomiting, and melena for 5 days. The patient endorsed a history of inconsistent NSAID use for the treatment of chronic headaches. She had no dysphagia, odynophagia, food impaction, constipation, hematemesis, hematochezia, or unintentional weight loss.

On admission, the patient was found to have symptomatic microcytic anemia ( Hgb 3.2), requiring ICU admission. She was initially empirically treated for suspected upper GI bleed and managed with a transfusion of 4 units of packed Red Blood Cells, IV pantoprazole and ceftriaxone. During the investigation, EGD was performed with no abnormal findings. She subsequently underwent a colonoscopy which showed helminths attached to the inner lumen of the cecum, with scattered small remnants of bleeding. Pathology of colonoscopy samples indicated Trichiura Trichuris as the causing organism. She was treated with 2 courses of albendazole. On outpatient follow-up symptoms had resolved, including no new episodes of melena.

Discussion: Helminthiasis represents a significant health problem worldwide, with an estimate of affecting around 19 % of the world's population. Melena is a rare symptom of trichuriasis infection, which, associated with iron deficiency anemia, would simulate an upper gastrointestinal bleed. Investigation for helminthiasis should be considered in patients with suspicion of GI bleed, especially in patients who immigrated from endemic areas.



Disclosures:


Beatriz Ximenes Braz, MSc, MD¹, Chaitra Banala, MD², William C. McGonigle, ³, Jorge R. Gonzalez, MD, MBA⁴, Rama Tarakji, MD⁵, Mahmoud Mahfouz, MD². P4124 - Trichuriasis Presenting With Severe Anemia and Melena: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.