Iron pill aspiration: Cytologic and histologic findings of a potential life‐threatening airway injury. A Case report and literature review

Abstract

Iron pill-induced injury of bronchial mucosa is a complication following accidental aspiration of an iron tablet. Oral iron supplementation is a common therapy, particularly among advanced-age patients, who are more prone to aspiration. However, iron pill aspiration has been rarely reported in the literature, usually under the format of short case reports, with only 32 cases published in the literature. The cytologic features suspicious for this rare but potentially lethal entity have been seldom described. We report a case of a patient diagnosed with iron pill-induced bronchial injury, after oral ferrous sulfate has been prescribed during a hospital admission for pneumonia. In the bronchial washing specimen, a background of necrotic cell debris and acute inflammation involving extracellular golden-brown fibrils positive for iron stains was seen, along with the yeast forms, which, in this clinical context could confirm the iron pill aspiration. Our aim is to highlight the cytology features associated with iron pill aspiration bronchitis, and to review the literature for the histologic, clinical, bronchoscopy, and treatment aspects.

Aspiration of zinc tablet leading to chemical burn of the airway

“…3). Despite the lack of visualization of the aspirated pill, this histopathology is similar to reports of other pill aspiration such as iron [3] and in the clinical context was consistent with airway inflammation from zinc exposure. The patient was discharged after two weeks of steroid therapy.…”

Magnesium Oxide as an Unexpected Bronchial Foreign Body in an Elderly Patient

“…In general, etiological materials can be identified with either an endobronchial biopsy or bronchoalveolar lavage, since most tablets dissolve in the airways ( 5 , 6 ). In contrast, magnesium oxide tablets barely dissolve in the bronchus because they dissolve according to the following chemical reaction: MgO+2HCl→MgCl 2 +H 2 O, where HCl is derived from gastric juices, which are absent in the airways ( 7 ).…”

Pleural effusion as a rare presentation of foreign body aspiration

“…Excessive mucosal contact with iron tablets induces mucosal damage in the upper gastrointestinal tract presumably through the toxic effects of iron oxidation [ 12 ]. Iron tablet aspiration into the respiratory tract is uncommon but can induce a severe and potentially fatal chemical injury [ 13 ]. Bronchoscopy reveals a golden-yellow, hemorrhagic, necrotic mucosa in the acute phase while bronchial stenosis is a common complication in the chronic phase [ 13 ].…”

“…Iron tablet aspiration into the respiratory tract is uncommon but can induce a severe and potentially fatal chemical injury [ 13 ]. Bronchoscopy reveals a golden-yellow, hemorrhagic, necrotic mucosa in the acute phase while bronchial stenosis is a common complication in the chronic phase [ 13 ]. In light of past reports, the amount of free radicals generated by iron oxidation and the duration from the aspiration of an iron pill to its removal apparently affect the severity of airway injury.…”