Choking on Success: Iron Pill Aspiration in a Marathon Runner
Recommended Citation
Virk HR, Childers J, Farra W. Choking on Success: Iron Pill Aspiration in a Marathon Runner. Am J Respir Crit Care Med 2025; 211:A2004.
Document Type
Conference Proceeding
Publication Date
5-20-2025
Publication Title
Am J Respir Crit Care Med
Abstract
A 42-year-old marathon runner presented with chest pain and shortness of breath two days after aspirating a slow-release iron pill. A chest CT revealed the pill lodged in her airway, necessitating prompt removal via bronchoscopy. During the procedure, the pill was extracted using forceps, revealing it had partially disintegrated coating the airway, a serious concern due to the rapid tissue injury caused by ferrous sulfate. The acidic pH of the pill and release of free radicals from oxidation of Fe2+ to Fe3+ contribute to severe mucosal damage. Iron pill aspiration injury progresses in two stages; erythema and inflammation with progression to fibrosis and airway stenosis. Early intervention is crucial to mitigate these risks. In this case, the patient was treated with antibiotics and a corticosteroid taper to reduce inflammation and facilitate healing.Two weeks later, a repeat bronchoscopy showed that the area of inflammation had cleared significantly, with little to no stenosis or residual iron deposits. This outcome highlights the importance of timely treatment, as the airway had healed well, avoiding the formation of scar tissue or fibrosis that could have led to long-term complications like airway narrowing or obstruction.In this patient, early removal of the pill, bronchial washing, and anti-inflammatory treatment likely helped prevent the more severe outcomes. Preventive measures such as early bronchoscopy and systemic steroids are key to inhibiting fibroblast activity and excessive granulation. Timely antibiotics also prevent post-obstructive pneumonia and additional mucosal damage. This case reinforces the importance of follow-up in preventing long-term complications like fibrosis, airway stenosis, or necrosis, demonstrating that early management and vigilant monitoring can lead to complete recovery without significant lasting damage.
Volume
211
First Page
A2004
