PICA with microcytic hypochromic anaemia and hookworm infestation: A case report

Major clinical manifestations of hookworm infestation are consequences of chronic intestinal blood loss. Iron-deficiency anaemia may occur and patient may develop pica which is commonly seen in children.Laboratory findings of hookworm infestation with iron deficiency anaemia include hypochromic microcytic anaemia and eosinophilia. B.A is a 7 year old boy residing at a village in Zamfara, North western Nigeria. He presented with a one month history of ingestion of stones and sand. He had normal neuro-developmental milestones and does not have any neuro-psychiatric disorder. He had mild generalised abdominal tenderness with multiple cystic swellings. On rectal examination, multiple stones were felt and evacuated which range between 1 and 3 cm. Blood film showed moderate anisocytosis with few target cells, hypochromia and microcytosis. Stool microscopy showed trophozoite of Entamoeba histolytica and eggs of hook worm. Pus cells with numerous blood cells were seen. Abdominal x-ray showed multiple dense radio opacities of calcific densities in the lumen of large bowel from caecum to rectum. He had enema and a total of 180 stones were passed within three days of admission. He was treated with Fersolate, Albendazole and Metronidazole and discharged after 8 days on admission when pica had stopped. He was asked to continue iron supplement for 3 months. Our case report is unique as stones passed out in stool were kept and counted. Enema may be needed for evacuation of larger stones. Children with pica should be evaluated for hookworm infestation and iron deficiency anaemia.