‘Iron lung’: Distinctive bronchoscopic features of acute iron tablet aspiration

Kim, Samuel T.; Kaisar, Omar M.; Clarke, Belinda; Vandenburg, Russell A.; Allen, David H.; Bell, Scott C.; Fong, Kwun M.

doi:10.1046/j.1440-1843.2003.00506.x

Cited by 25 publications

(28 citation statements)

References 8 publications

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“…Kim et al 5 described grossly inflamed golden-yellow bronchial mucosa with ulceration and sloughing in three patients with iron tablet aspiration. In another case, atypical squamous cells were found in bronchial washings and squamous metaplasia found on bronchial mucosal biopsy 6.…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopic and histological changes over time following acute ferrous sulphate tablet aspiration

2012

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Section: Discussionmentioning

confidence: 99%

Bronchoscopic and histological changes over time following acute ferrous sulphate tablet aspiration

2012

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“…In case 2, coughing up the well-preserved tablet after weeks is surprising, and in contrast to cases describing dissolved tablets with remaining severe, local injury and inflammation in the lungs 3 7Learning points

Both cases and the literature highlight the need for increased clinical suspicion and early bronchoscopy on wider indications in patients with persistent symptoms without an obvious diagnosis or with insufficient response to treatment.

Most certainly, if aspiration is suspected, it should result in prompt bronchoscopy.

Foreign body aspiration is common; however, it is underdiagnosed and diagnostic delay is typical.

…”

Section: Discussionmentioning

confidence: 87%

Airway foreign body aspiration: common, yet easily overlooked! Two interesting cases

et al. 2015

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Two cases: A 66-year-old woman was referred to the hospital due to dyspnoea and cough. Seven months prior to referral, the patient had choked on a chunk of nut and grain-filled bread. She had daily cough and dyspnoea. The patient was convinced of an airway foreign body and she contacted her general practitioner and the emergency service several times; they all found this unlikely. Fibre optic bronchoscopy revealed two obstructing nut-like foreign bodies in the right upper and lower lobe, respectively. A 77-year-old man with sarcoidosis developed increased dyspnoea and sputum production. Three weeks earlier, the patient had choked on a magnesium tablet. Everyone was convinced that the tablet had dissolved. Infection was suspected. Chest CT scan was performed showing no obvious signs of infection or progression in sarcoidosis. After the CT scan, the patient coughed up the remains of the tablet and his symptoms resolved. Retrospective evaluation of the CT scan revealed the tablet.

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“…The mucosal toxicity of ferrous sulfate has also been reported for the hypopharynx,12 the esophageal lumen,13 and (after inhalation of a tablet) the tracheobronchial tree 14,15…”

Section: Discussionmentioning

confidence: 89%

Ulceration of the oral mucosa following direct contact with ferrous sulfate in elderly patients: a case report and a review of the French National Pharmacovigilance Database

Liabeuf¹,

Gras²,

Moragny³

et al. 2014

CIA

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ObjectiveTo report a series of cases of ulceration of the oral mucosa linked to direct contact with ferrous sulfate in elderly patients.Case summaryThe first case report concerns the occurrence of widespread oral ulceration in an 87-year-old woman with Alzheimer’s disease. The ulceration extended from the side of the tongue to the floor of the mouth. No clear explanation was found and various local treatments were ineffective. Once it was realized that the ferrous sulfate tablets (given as an iron supplement) were crushed prior to administration (due to the patient’s deglutition disorder), withdrawal of this treatment led to rapid resolution of the ulceration. Nine other cases of oral ulcerations associated with ferrous sulfate were identified in the French National Pharmacovigilance Database. All but one of the patients were over 80 years of age and the youngest patient (a 54-year-old) had dysphagia associated with facial paralysis.DiscussionOnly two other reports of oral ulceration due to ferrous sulfate have been published to date. Mucosal toxicity of ferrous sulfate (which is probably related to oxidative stress) has previously been reported for the hypopharynx, the esophageal lumen, and (after inhalation of a tablet) the tracheobronchial tree.ConclusionThe mucosal toxicity of ferrous sulfate must be taken into account when deglutition disorders are present (as in elderly patients) and appropriate pharmaceutical formulations (such as syrups) should be administered to at-risk patients. The use of iron salts other than ferrous sulfate could be considered.

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‘Iron lung’: Distinctive bronchoscopic features of acute iron tablet aspiration

Cited by 25 publications

References 8 publications

Bronchoscopic and histological changes over time following acute ferrous sulphate tablet aspiration

Bronchoscopic and histological changes over time following acute ferrous sulphate tablet aspiration

Airway foreign body aspiration: common, yet easily overlooked! Two interesting cases

Ulceration of the oral mucosa following direct contact with ferrous sulfate in elderly patients: a case report and a review of the French National Pharmacovigilance Database

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