Desiderosmia as the presenting feature of iron deficiency anaemia secondary to undiagnosed ulcerative colitis in an adolescent – A Case Report
This case report describes a 15-year-old boy whose compulsive craving to smell non-food substances (desiderosmia) served as the presenting symptom of severe iron deficiency anaemia caused by previously undiagnosed ulcerative colitis, a condition that resolved following appropriate medical treatment.
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In the human body, iron acts as a vital transport system, carrying oxygen to every cell to keep energy levels steady and organs functioning. When this supply runs low, a condition known as iron deficiency anaemia develops, often revealing itself through familiar signs like extreme tiredness, pale skin, or a craving to eat non-food items like dirt or ice. However, the body sometimes signals a shortage in stranger, less recognized ways. One such signal is a powerful, compulsive urge to smell specific odors, particularly strong chemical scents like gasoline or cleaning fluids. This phenomenon, distinct from eating the substance, has been linked to low iron levels in medical literature, yet it remains a rare and often overlooked clue that can hide a more serious underlying illness.
This story begins with a fifteen-year-old boy who arrived at a clinic with a baffling and persistent behavior: an irresistible need to inhale the fumes of petrol and kerosene. For a year, he had been drawn to these strong smells, a habit that had grown from accidental exposure in his father's vehicle repair garage into a compulsive routine. Alongside this urge, he felt a mild tiredness when he exerted himself, but he denied the classic symptoms of severe illness, such as breathlessness or the desire to eat non-food items. He appeared thin and pale, but otherwise, his physical examination was unremarkable, with no signs of the swollen glands or organ enlargement that often accompany serious disease. The medical team faced a difficult puzzle: was this a behavioral issue, a psychological habit, or a sign of a physical problem?
To solve the mystery, the doctors ran a series of tests that revealed a startling reality. The boy's blood showed severe anaemia, with a level of oxygen-carrying protein dropping to just 5.8 grams per deciliter, far below the normal range for a teenager. His red blood cells were small and pale, and his body was producing too many platelets, a sign of stress and inflammation. Crucially, a marker in his stool indicated active inflammation in his lower gut. When doctors looked inside his colon with a camera, they found continuous redness and fragile tissue, confirming a diagnosis of ulcerative colitis, a chronic condition where the lining of the bowel becomes inflamed. This inflammation was the root cause of his iron loss, even though he had not experienced the dramatic bleeding or severe diarrhea that typically alerts people to such a disease.
The treatment plan addressed both the immediate danger and the root cause. The boy received a blood transfusion to quickly raise his levels, followed by medication to calm the inflammation in his colon and supplements to rebuild his iron stores. The result was swift and decisive. Within a few weeks of starting this treatment, the boy's intense craving to smell kerosene vanished completely. His blood counts began to recover, and the compulsive behavior that had dominated his life for a year disappeared as his body's iron levels were restored.
This case highlights a critical lesson for medical care: strange sensory cravings can be the first and only warning sign of a serious physical deficiency. The boy's experience demonstrates that when a patient presents with an unusual urge to smell specific substances, it should trigger an investigation for iron deficiency, even if they appear otherwise healthy. In this instance, recognizing the link between the smell craving and the blood deficiency allowed doctors to uncover an undiagnosed bowel disease that might have gone unnoticed for years. By treating the iron shortage, the doctors not only corrected the blood disorder but also eliminated the dangerous habit of inhaling toxic fumes, preventing potential harm to the boy's lungs and brain. The resolution of his symptoms confirms that what looked like a behavioral quirk was, in fact, a direct physical response to a lack of iron, a connection that, once identified, led to a full recovery.
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