Severe Endobronchial Inflammation Induced by Aspiration of a Ferrous Sulfate Tablet

Abstract

Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation.

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

“…The mean age was of 68.5 years (range of 36–92 years). In only 50% of the cases the aspiration event was noticed by the patient or recalled after a detailed clinical history taken retrospectively . The most frequent symptoms in the acute phase, defined as the first two weeks after the aspiration event, where coughing (53%), four patients presented with brown sputum and eight with obvious hemoptysis .…”

“…In only 50% of the cases the aspiration event was noticed by the patient or recalled after a detailed clinical history taken retrospectively. 6,7,[9][10][11]13,14,19,22,23,27 The most frequent symptoms in the acute phase, defined as the first two weeks after the aspiration event, where coughing (53%), four patients presented with brown sputum and eight with obvious hemoptysis. 12,13,19,20,23,25 Two cases presenting with hemoptysis were fatal due to massive lung haemorrhage.…”

“…Other less common symptoms were pleuritic pain and burn sensation, reported in six cases, and epigastric discomfort. 7,9,14,20,[23][24][25] Inflammation associated with brown tablet remnants lasted for 10 days. Two months later there was granulation tissue.…”

“…7,10,25 Bronchoscopy examinations performed in the acute phase, consistently revealed a yellow-brown discolored, necrotic mucosa, occasionally forming a polypoid mass, markedly friable with easy bleeding when touched. [7][8][9][10]12,13,15,19,20,[23][24][25] Necrosis, inflammation, and pigments were reported to last up to two months. 14,[20][21][22] Including our case, three other cases had cytologic specimens collected along with biopsy.…”

“…Iron pill aspiration events can occur unbeknownst to the patient and produce only relatively non‐specific symptoms in the acute phase, such as chronic cough and wheeze . Therefore, the recognition of its morphologic aspects is critical to its diagnosis and timely treatment, in order to prevent complications.…”