A 60-year-old male farmer from South Asia was diagnosed with severe iron deficiency anemia and koilonychia after endoscopy revealed duodenal ascariasis, according to two medical reports published October 4, 2026, including one from Cureus and a World Health Organization (WHO) report on iron supplementation.
Clinical Presentation and Diagnosis
The patient presented with exertional dyspnea, generalized weakness, and spoon-shaped nails (koilonychia), alongside a hemoglobin level of 4.2 g/dL, serum ferritin of 1.92 ng/mL, and low serum iron. Upper gastrointestinal endoscopy identified multiple live Ascaris lumbricoides worms in the duodenum, linking the parasitic infection to his severe anemia. According to the WHO, iron deficiency anemia is a common condition that can arise from chronic blood loss, dietary insufficiency, or parasitic infections, particularly in endemic areas.
Clinicians emphasized that koilonychia, while strongly associated with chronic iron deficiency, can also signal other conditions like celiac disease or thyroid dysfunction. However, the combination of endoscopic findings and laboratory data confirmed parasitic infestation as a contributing factor, alongside malnutrition and poor hygiene practices linked to his agricultural work. The WHO report highlights that soil-transmitted helminths, including Ascaris, are linked to poor sanitation and occupational exposure, as seen in this case.
The case report, titled Severe Iron Deficiency Anemia With Koilonychia and Endoscopically Detected Duodenal Ascariasis in an Elderly Male: A Case Report, was published by Cureus on October 4, 2026, and authored by Rotshi S, Mondal S, Biswas S, et al. The patient’s history of poor hygiene practices while working on the farm, such as not consistently washing hands or fruits before eating, was noted as a potential risk factor for parasitic infection. This aligns with WHO guidelines emphasizing the role of sanitation in preventing helminth transmission.
Treatment and Recovery
Treatment included albendazole for parasite clearance, red cell transfusions, and oral iron supplementation. Three months later, the patient showed marked improvement: hemoglobin levels rose to near-normal, serum ferritin normalized, and koilonychia resolved. The case highlights the importance of considering parasitic infections in endemic regions, even in elderly patients. The WHO advises daily iron and folic acid supplementation for pregnant women in areas with high anemia prevalence.
Both reports stressed that while stool microscopy remains a standard diagnostic tool, endoscopy should be used strategically in unexplained severe anemia cases. The WHO notes that iron deficiency can also impair immune function and work capacity, as seen in this patient’s generalized weakness and fatigue.
The WHO’s 2018 report Developing and validating an iron and folic acid supplementation indicator for tracking progress towards global nutrition monitoring framework targets outlines specific guidelines for supplementation. For pregnant women, the recommended daily dose is 30-60 mg of iron and 400 µg of folic acid, with higher doses advised in settings where anemia prevalence exceeds 40%. While this case involved a non-pregnant patient, the findings reflect broader challenges in addressing iron deficiency across demographics.
Public Health Implications
The case reinforces the need for targeted screening in areas with poor sanitation and high prevalence of soil-transmitted helminths. Ascariasis, though less directly linked to iron loss than hookworm, can exacerbate anemia through nutritional competition and gastrointestinal disturbances. Public health initiatives should focus on hygiene education and access to antiparasitic treatments. The WHO advocates for daily iron and folic acid supplementation in settings where anemia prevalence among pregnant women exceeds 40%, a threshold relevant to understanding broader public health strategies in endemic regions.
The WHO report underscores the importance of integrating iron supplementation into antenatal care, though this case illustrates the persistent challenges of parasitic infections in non-pregnant populations.
The article was edited by Priya Deshmukh, a senior editor at archyde.com and practicing physician, who has been recognized for her investigative reporting on public health. Her role in contextualizing the clinical findings within broader nutritional frameworks is noted in the source material.
Why This Matters
The complex interplay between parasitic infections, nutritional deficiencies, and aging is evident in this case. It serves as a critical reminder for clinicians to consider non-traditional causes of anemia in high-risk populations, ensuring timely intervention to prevent long-term complications. The WHO’s guidelines on iron supplementation, while focused on maternal health, highlight the systemic nature of iron deficiency as a public health issue, affecting diverse demographics including elderly agricultural workers.
The findings align with the WHO’s Global Nutrition Monitoring Framework, which tracks progress toward targets for reducing anemia. The framework includes indicators for iron and folic acid supplementation, emphasizing the need for data-driven strategies to address malnutrition. This case illustrates how parasitic infections can complicate nutritional interventions, reinforcing the importance of integrated approaches to public health.