Knowledge Check

Sort the clinical manifestations (top) with the underlying cause (bottom):

Headache
Shortness of breath
Alopecia
Koilonychia
Chest pain
Palpitations
Pallor
Angular cheilitis
Pica
Restless legs syndrome
Iron deficiency
Anemia

True of false: patients rarely volunteer a history of pica; they must be asked specifically about the symptom.

a
True
b
False

Severe koilonychia. Source.

A very rare presentation of iron deficiency is the Plummer-Vinson syndrome:

  • Reported in < 0.1% of cases of iron deficiency.
  • Associated with classic triad of:
    • Dysphagia
    • Iron deficiency anemia
    • Upper esophageal webs
  • Pathogenesis of Plummer-Vinson syndrome remains speculative:
    • Depletion of iron-dependent oxidative enzymes may produce:
      • Myasthenic changes in muscles involved in the swallowing mechanism
      • Atrophy of the esophageal mucosa
      • Formation of webs as epithelial complications
    • Improvement in dysphagia after iron therapy provides evidence for an association between iron deficiency and postcricoid dysphagia.
Upper esophageal webs seen on barium swallow.