Can pinworms cause extreme fatigue?

No: Pinworms exist like the germs who live in your poop. Their basic symptom (itching) is caused after the female lays eggs around the anus in a sticky goop. That sticky goop triggers a irritant rash that leads to the itching. You would otherwise never know they were there just like you are not bothered by the germs/yeast living harmlessly in your gut.

Pinworms: That is possible. Some people who are infected with pinworm have restless sleep or keep waking up due itching in the anal area. If a person becomes sleep deprived, they become fatigued.

Rarely: Usually pinworms don't have any symptoms. Once in a while the anal area itches, worse at night as a symptom. That symptom could lead to disrupted sleep but usually does not. If you have extreme fatigue, most likely, there is something else going on.