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\begin{document}

\title{A Rare Form of Pica}



\author[1]{Daniel Kurtz}%
\author[2]{Ibrahim  Azar}%
\affil[1]{Detroit Medical Center}%
\affil[2]{Karmanos Cancer Center}%


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  \date{March 15, 2025}


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Here we present a case report of Xylophagia%
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\section*{A Rare Form of Pica}

{\label{a-rare-form-of-pica}}

Daniel Kurtz, MD\textsuperscript{1}, Ibrahim Azar,
MD\textsuperscript{2}, Indryas Woldie, MD\textsuperscript{2}

Affiliations:

1 -- Department of Internal Medicine, Wayne State University School of
Medicine and Detroit Medical Center, Detroit, MI, USA

2 -- Department of Oncology, Wayne State University, Karmanos Cancer
Center, Detroit, MI, USA

Disclosure: We have no conflicts of interest to declare

Corresponding author: Daniel Kurtz M.D.

Corresponding author contact information: fs9227@wayne.edu

Author contribution statement: Daniel Kurtz and Ibrahim Azar wrote the
manuscript. All authors reviewed the final manuscript.

A 32-year-old woman with a history of homozygous sickle cell anemia (Hgb
SS disease) was started on anticoagulation with apixaban 5mg BID for
superior vena cava thrombosis and pulmonary embolism. She developed
hematochezia on anticoagulation and workup revealed iron deficiency
anemia {[}ferritin 8.1 ng/ml (11-306.8 ng/ml), Hemoglobin 7.0gm/dl
(11.5-15.1 gm/dl), MCV 77.4 fl (82-97 fl{]}. Colonoscopy revealed
extensive foreign body, throughout the colon making it difficult to
advance the colonoscope beyond the sigmoid colon. Patient was given
additional polyethylene glycol 3350 and electrolytes followed by repeat
colonoscopy with assistance from large volume of water evacuation, which
showed small fragments of toilet paper (Figure A, B, \emph{arrows} ) up
to the terminal ileum. No active source of bleeding was identified. Upon
further questioning, patient reported pica and craving for toilet paper
and endorsed eating up to two rolls of toilet paper daily. She received
three doses of intravenous iron replacement therapy with resolution of
her pica and normalization of her ferritin. Xylophagia is a form of pica
where patients have the unusual craving for ingestion of paper {[}1{]}.

Key Clinical Message: Xylophagia is a form of pica where patients have
the unusual craving for ingestion of paper. Cravings can resolve after
iron replacement therapy.

References:

Coltman CA. Pagophagia and iron lack.~JAMA.~2004;207:513--6\selectlanguage{english}
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