A 23-year-old woman from Saudi Arabia with a severe case of iron deficiency was admitted at a hospital. Experts traced the condition from infestation of head lice.

The woman's symptoms included palpitations, chest discomfort, dizziness and fatigue. Blood tests reveal an extremely low hemoglobin count of 2.2 g/L. When the woman first arrived at the emergency room, she was pale and frail-looking. She also showed symptoms of fatigue and was largely indifferent to conversation.

Lab investigations and medical history analysis did not reveal other causes of anemia. The woman's albumin test showed normal levels.

Medical history showed she suffered from secondary amenorrhea, a case wherein a woman who typically goes through normal menstrual cycles suddenly stops getting her menstrual cycles for at six months or even longer. However, her physical examination results showed chronic infestation of head lice, with lice nits quite visible. There were also scratch marks found on her scalp. The doctors did not find presence of lice in other parts of her body including the pubic hair area.

"Although no causal relationship between head lice infestation and iron deficiency anemia has been established, several case reports have described iron deficiency anemia in individuals with heavy and chronic lice infestation in the absence of other causes of iron deficiency anemia," said authors in the case report.

Previous case reports on iron deficiency linked with lice infestation focused on homeless persons who have inadequate access to hygiene. The 23-year-old woman suffers from depression that affects her hygiene. Her depression started when her mother passed away four years earlier. She had no prior history of hospital admission or chronic mental condition.

A blood transfusion covering two units of packed red blood cells increased the woman's hemoglobin levels to 5 g/L. She was treated with permethrin (0.4%), a synthetic chemical commonly used as an insect repellent or insecticide. She was then provided with intravenous iron therapy to battle her anemia and a medicated shampoo for the lice infestation. The female patient was also referred to a gynecologist for the treatment of her secondary amenorrhea.

The case report was published in The British Medical Journal on Nov. 5.

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