OSU Department of Pathology

Anatomical Pathology Interesting Case Conference

Microscopic description and IHC:

The esophageal biopsy shows acute esophagitis with associated brown crystalline and fibrillary material consistent with iron deposition. Iron staining is positive in these areas. HSV and PASD stains are negative.

Discussion:

A history of ferrous sulfate ingestion was noted upon review of the medical record. Erosive esophageal mucosal injury from iron tablet ingestion at therapeutic levels is well documented. This condition is found in almost 1% of all upper gastrointestinal endoscopy exams and is important to keep in mind when brown crystalline material is identified in biopsy tissue. The injury is reversible with discontinuation or switching to alternative forms of iron supplementation.

References:

Abraham SC, Yardley JH, Wu TT. “Erosive injury to the upper gastrointestinal tract in patients receiving iron medication: an under recognized entity.” Am J Surg Pathol. 1999 Oct;23(10):1241-7

Case Images