Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Iron deficiency anemia is commonly seen in the emergency department, and the cause can be complex and variable.  Chronic lice infestation as the etiology of severe iron deficiency anemia has not been well studied and is mostly limited to case reports. Case Report: We present a case of a female without known medical history who presented to the emergency department for generalized weakness and was found to have severe anemia in the setting of chronic lice infestation.  This patient’s hypotension was initially unresponsive to fluid resuscitation which allowed for consideration of other etiologies of this patient’s presentation and an unusual case of severe anemia. Conclusion: Severe and chronic pediculosis can cause chronic blood loss and be an unusual and rare cause of iron deficiency anemia.  In the setting of anemia and hypotension unresponsive to fluid resuscitation, consideration should be given to early PRBC transfusion and subsequent investigation of causes of severe anemia.