Obliterating Bronchiolitis: Result of Iron Pill Aspiration

Foreign body aspiration occurs in all age groups, especially in children and the elderly. The aspiration of an organic foreign body such as iron sulfate can cause significant bronchial destruction via oxidizing necrosis. When iron comes into contact with bronchial mucosa, it gets oxidized from ferrous ions into a ferric form which is highly toxic to the mucosa causing severe inflammation, mucosal damage, and fibrosis. Physicians should be very prudent with prescribing iron sulfate or any other pills in individuals who are at high risk of aspiration. Diagnosis is based on the history of iron aspiration, intense airway inflammation or necrosis on bronchoscopic examination, and iron particles observed on pathology. Prompt diagnosis and management should take place to prevent further morbidities. We report a case of 61-year-old female who was admitted to the hospital with a four-week history of aspirating iron pill. Computed tomography (CT) of the thorax showed ground glass infiltrates in the right lower lobe. She underwent flexible bronchoscopy which showed distal right bronchus intermedius (RBI) necrosis and stenosis with near-complete obstruction of distal RBI. She underwent multiple advanced bronchoscopic interventions with minimal improvement of the obliterated bronchus.