Iron-Deficiency Anemia and Pica for Tomato Seeds

To the Editor: We would like to describe a patient with iron-deficiency anemia, an unusual pica, and an esophageal web. A 53-year-old woman presented with a dry mouth, cracked lips, and a swollen, painful tongue. One year before, she had had difficulty in eating because of a sore mouth. In the next eight months dysphagia of liquids and solids had developed. Six months before presentation she acquired an intense craving for tomato seeds. She constructed an elaborate strainer to retrieve the seeds from three 1-lb (0.45-kg) cans of cooking tomatoes every day. Her increasing dysphagia forced her to purée the . . .