title: A Curious Case of Iron-Deficiency Anemia.
abstract: A 49-year-old Brazilian male presented to the emergency department with a five-day history of abdominal pain, dark stools, and syncope. Physical examination did not reveal any melena on digital rectal examination and there were no stigmata of chronic liver disease. Laboratory results showed hemoglobin of 47 g/L, MCV of 80 fL, and ferritin of 6 ng/mL. Liver enzymes and liver function tests were normal. Abdominal ultrasound showed a cirrhotic liver with splenomegaly and varices suggestive of portal hypertension. His past history was significant for cirrhosis based on a previous variceal bleed but a workup for chronic liver disease was negative and a liver biopsy did not show steatosis, fibrosis, or cirrhosis. A gastroscopy in this admission showed large esophageal varices without high-risk stigmata and no overt bleeding was seen. A colonoscopy was subsequently completed to the terminal ileum and was normal aside from a 5 mm sessile polyp in the descending colon.
authors.affiliation: Department of Medicine, Queen's University, Kingston General Hospital, Kingston, ON, Canada K7L 2V7.
authors.forename: Seth
authors.identifier: 0000-0002-9872-6832
authors.initials: S
authors.lastname: Shaffer
authors.affiliation: Toronto Centre for Liver Diseases, Toronto General Hospital, University Health Network, Toronto, ON, Canada M5G 2C4.
authors.forename: Mayur
authors.initials: M
authors.lastname: Brahmania
authors.affiliation: Toronto Centre for Liver Diseases, Toronto General Hospital, University Health Network, Toronto, ON, Canada M5G 2C4.
authors.forename: Hemant
authors.identifier: 0000-0002-6423-2383
authors.initials: H
authors.lastname: Shah
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012555:Schistosomiasis mansoni / Q000150:complications*