A teenager took iron pills for her iron deficiency anaemia but ended up with erosive gastritis
A 14-year-old female presented with a history of 8 episodes of fresh blood in the vomitus during the past 8 hours before presentation. Each time she vomited approximately 100-150 mL of blood. Moreover, she had nausea and melena for the past 5 days along with epigastric pain. The patient’s past medical history revealed a diagnosis of iron deficiency anaemia around 1 month ago. She was taking oral iron pills (ferrous sulfate compounds) for the past 2 weeks. Each time she took her pills almost 2 hours after meals.
Clinical examination revealed ailing face, pallor, and diffuse abdominal tenderness.
Serological investigations revealed anaemia, elevated serum iron levels, elevated liver transaminases. However, her ferritin levels were low but both total iron-binding capacity and transferrin levels were normal.
His blood results showed the following:
Hemoglobin 11.2 g/dL
Hematocrit: 35.2%
Serum iron levels: 51.56 μmol/L
Ferritin: 6.7 ng/mL
AST: 404.8 U/L
ALT: 429.7 U/L
GGT: 52 U/L
LDH: 334 U/L
Coagulation profiles was in normal ranges.
Since the biomarkers for viral hepatitis were negative and the markers for autoimmune hepatitis were normal, the doctors excluded acute liver pathology and autoimmune hepatitis. Moreover, serology did not reveal any indication of parasitic infection.
Anti-transglutaminase and anti-endomysial antibodies were normal, therefore, the doctors ruled out celiac disease.
The abdominal ultrasound was unremarkable. Upper digestive endoscopy revealed brown deposits on the gastric mucosa, edematous gastric folds, and multiple hemorrhagic lesions of the gastric mucosa. There were erosions all over the gastric mucosa, however, erosions were more severe in the antral part.
The histopathological evaluation of the duodenal biopsies was normal. However, biopsies from the gastric mucosa pointed out erosions, numerous intraepithelial neutrophils, in the mucosal chorion with an abundant polymorph inflammatory infiltrate and multiple brown deposits defining the presence of iron at this level.
With the biopsy findings, she received a diagnosis of acute hemorrhagic gastritis secondary to oral iron supplements.
On admission, the doctors performed gastric lavage with a hemostatic drug. The patient also received intravenous proton pump inhibitors and amino acids for 5 days. Moreover, she also received intravenous normal saline and dextrose.
The patient showed remarkable improvement; therefore, she was discharged with a prescription of proton pump inhibitor and liver protectors orally for 1 month.
At the 1-month follow-up, repeat serology revealed the persistence of iron deficiency anaemia, but the liver biomarkers were in normal ranges.
A repeat endoscopy showed normal gastric mucosa. Moreover, the histopathological evaluation did not point out the presence of iron in the gastric mucosa. The doctors recommended a liquid-form of iron supplement for 1 month to correct the iron-deficiency anaemia.
Reference:
Meliţ LE, Mărginean CO, Mocanu S, Mărginean MO. A rare case of iron-pill induced gastritis in a female teenager: A case report and a review of the literature. Medicine (Baltimore). 2017;96(30):e7550. doi:10.1097/MD.0000000000007550
