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Unusual Cause of Persistent Cough: 'Pill Aspiration'

      A 57-year-old woman with carcinoid syndrome was referred to the pulmonary clinic by her primary care physician (PCP) for persistent cough for the past 6 weeks. She was evaluated by her PCP approximately 6 weeks earlier for cough, which the patient thought started after she had aspirated one of her medications. Results from initial clinical evaluation and chest radiography done by her PCP were normal. When we evaluated, her vital signs were within the normal range. She had wheeze on chest auscultation. Because she had several weeks of persistent cough and likely had aspirated a pill, we decided to proceed with bronchoscopy. Aspirated material was found in the right lower lobe. Black fragments were seen, and intense inflammatory reaction with granulation tissue, leading to bronchial stenosis, was noted (Figure). Histology showed benign bronchial cells with numerous inflammatory cells and alveolar macrophages, and foreign material consistent with iron was seen on iron stain, which was consistent with iron pill aspiration. The patient was referred for advanced bronchoscopy and endobronchial interventions because of the extent of bronchial tissue injury and stenosis.
      Figure
      FigureBronchoscopy showing pill fragments (arrow) with intense inflammatory granulation response with bronchial stenosis.
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