An unexpected cause of severe anemia in an adult patient: a pharyngeal leech (with video).

摘要

A 55-year-old man presented with fatigue, tachycardia, and a tickling sensation in his throat. Physical examination revealed only conjunctival pallor and tachycardia. Laboratory test findings were normal, other than iron deficiency anemia, with a hemoglobin of 8.8 g/dL (normal 14-18 g/dL), fenitin of 5 ng/mL (30-200 ngiL), serum iron of 20 mug/dL (59-158 mug/dL), and serum iron binding capacity of 454 mug/dL (200-400mug/dV). Upper GI endoscopy revealed a leech causing hemorrhage in the pharynx (A) (Video 1, available online at www.giejournal.org). The leech was removed by an otolar-yngologist and was approximately 33 mm long. Endoscopic examinations of other parts of the GI tract "were unremarkable. The patient reported that he regularly drank spring water in his village. Oral iron replacement was initiated. The patient became asymptomatic, and at the 3-month follow-up visit, the anemia had resolved