Koilonychia from Iron-Deficiency Anemia

This is an answer to the Case – Spoon-Shaped Nails

A 26-year-old malnourished woman presented with a 4-day history of mouth pain and a 3-month history of fatigue, general malaise, and palpitations.

Physical examination revealed pallor of the conjunctiva and nail beds, as well as koilonychia (spoon-shaped nails). Laboratory studies revealed a hemoglobin level of 30 g per liter, a platelet count of 45,000 per cubic millimeter, and a leukocyte count of 4100 per cubic millimeter.

Iron studies were not done, because of financial limitations; however, the clinical and laboratory findings were suggestive of iron-deficiency anemia.

Intraoral examination revealed an abscess, which was drained. The patient underwent blood transfusion; the repeat hemoglobin level was 71 g per liter, and there was clinically significant improvement in her systemic symptoms.

The cause of the iron deficiency was not identified but was presumed to be related to hookworm infestation, which had a high local prevalence.

She was given albendazole empirically, and iron supplementation was begun on discharge. The patient returned 3 weeks later for tooth extraction, and her general condition was found to have improved.

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