Aspiration of iron pill containing ferrous sulfate into the airway can induce fulminant chemical burn and necrosis of the airway mucosa. Acute chemical burn and inflammatory response can result in life-threatening airway compromise. It can also result in long-term sequelae including but not limited to fibrosis and airway stenosis. Considering the common use of iron supplements, and the potential severity of aspiration related airway injury, clinicians should be fully cognizant of the interaction between aspirated iron and airway passages. Herein, we present a case report with pertinent review of the literature.