Intermittent Bloody Emesis in a Patient with Iron Deficiency Anemia

Excerpt

A 61-year-old female with newly diagnosed iron deficiency anemia presented with intermittent hematemesis. Laboratory examination revealed a decreased hemoglobin (10.5 g/dL), normal serum iron (147 μg/dL), normal ferritin (97 ng/mL), and normal iron saturation (37%). Endoscopy was done and showed islands of salmon-colored mucosa interspersed with superficial linear ulceration (Fig. 1). Biopsies were taken for pathology and revealed ulcerated esophagitis characterized by focal necrosis, fibrin and inflammatory cells. Prussian blue stain was performed (Fig. 2) and highlighted iron deposition in the ulcerated esophageal squamous epithelium. The patient was diagnosed with iron pill esophagitis secondary to oral ferrous sulfate treatment.

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