Introduction: Accidental aspiration of tablets is usually benign; however, ferrous sulfate tablets are erosive and can cause severe mucosal damage if aspirated- a rare but life-threatening complication. Few cases have been published since 1996; most describe rapid chemical burns, airway necrosis, and in several reports, acute respiratory failure. We present a case of iron pill aspiration leading to necrotizing bronchial injury, lobar collapse, and hypoxic respiratory failure requiring ICU care. Description: An 82-year-old female with a past medical history of esophageal strictures, breast and lung cancer (s/p right lobectomy), CAD, and a prior CVA presented after choking on an iron pill, followed by chest pain and dyspnea. On arrival, she was hypoxic to 89%. A CT angiogram showed complete opacification of the right mainstem and a right pulmonary vein thrombosis. After a rapid decline in oxygenation, she was placed on a 15-L Non-rebreather mask, and a chest X-ray showed signs of obstructive atelectasis. Her condition continued to deteriorate and she was intubated and underwent emergency bronchoscopy, which revealed a dark, friable foreign body obstructing the bronchus intermedius with surrounding necrotic and sloughing mucosa. The iron pill was fragmented and removed piecemeal with lavage and forceps. Follow-up bronchoscopy showed persistent mucosal ulceration but no retained material. She was treated with Unasyn, Levophed and was extubated 2 days after to HFNC. Discussion: This case illustrates how iron pills, unlike most oral medications, can cause direct chemical burns to bronchial tissue when aspirated. The aspiration led to lobar collapse, airway obstruction, necrosis and intubation. The severity of mucosal damage from elemental iron, as confirmed bronchoscopically, reinforces the need to avoid such medications in patients with known or suspected dysphagia. While iron-deficiency anemia is common in the elderly, its treatment should be weighed against rare but devastating risks in those with impaired swallowing or structural esophageal disease. Iron pill aspiration is preventable, and iron supplementation should be prescribed cautiously. Pre-discharge swallowing assessments and consideration of alternative formulations (e.g., liquid or IV iron) are essential to avoid serious complications.
ABUZAID et al. (Sun,) studied this question.