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Severe Airway Injury Due to Dental Use of High-Concentration Hydrogen Peroxide: Case Study
Algeria: A new case report published in Cureus has highlighted that hydrogen peroxide inhalation during dental whitening can lead to massive hemoptysis and a tumor-like endobronchial obstruction. The case highlights the potential for significant airway injury after exposure to high-concentration hydrogen peroxide and emphasizes the need to consider such iatrogenic causes in patients presenting with unexplained hemoptysis and atelectasis.
The report by Redouene Sid Ahmed Benazzouz and colleagues from the Pulmonology Department at Laghouat Public Hospital, Algeria, describes a 55-year-old North African woman who was admitted with massive hemoptysis. She had a three-month history of persistent dry cough, initially accompanied by a minor episode of hemoptysis and later progressing to breathlessness at rest. She had no history of smoking, chronic respiratory disease, coagulation disorders, or significant environmental exposures.
Importantly, the onset of her symptoms followed a dental whitening procedure using 35% hydrogen peroxide. The session was complicated by severe throat pain, oral ulcerations, and intense coughing. However, this exposure was not disclosed during her initial evaluation and was revealed only retrospectively.
On examination, reduced breath sounds were noted over the left lung field. Laboratory tests, including inflammatory markers and coagulation profile, were within normal limits. Chest X-ray demonstrated mediastinal shift toward the left and elevation of the left hemidiaphragm, suggestive of substantial lung collapse. A chest CT scan revealed a soft-tissue-density lesion obstructing the left lower lobar bronchus, resulting in complete left lower lobe atelectasis and associated consolidation. The radiologic appearance raised suspicion of an endobronchial tumor.
CT pulmonary angiography excluded pulmonary embolism and vascular malformations, while repeated sputum tests were negative for tuberculosis. Flexible bronchoscopy was attempted but discontinued due to hypoxemia and hemodynamic instability. Thick mucus was observed obstructing the bronchus, without a clearly defined solid mass. Shortly after the procedure, the patient expectorated a large amount of dense mucus and experienced gradual clinical improvement. Microbiological analysis of the secretions did not identify any infectious cause.
The patient was managed conservatively and discharged in stable condition. Follow-up imaging four months later showed complete resolution of the endobronchial lesion and full re-expansion of the lung, with no recurrence of symptoms.
The authors suggest that accidental inhalation of concentrated hydrogen peroxide likely caused reversible chemical injury to the airway, mimicking malignancy on imaging. Although limited by the absence of histologic confirmation and incomplete bronchoscopic evaluation, the case highlights the importance of considering chemical exposures in unexplained airway obstruction and reinforces the need for caution in cosmetic dental procedures involving high-concentration oxidizing agents.
Reference:Benazzouz R, Benyagoub M, Nedjar N (January 21, 2026) Hydrogen Peroxide Inhalation During Dental Whitening Leading to Massive Hemoptysis and Tumor-Like Endobronchial Obstruction: A Case Report. Cureus 18(1): e102009. doi:10.7759/cureus.102009
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