An Interesting Case of Persistent Pyrexia With Eosinophilia and Pulmonary Infiltrates: “Popcorn Aspiration”

Abstract

SESSION TITLE: Chest Infections I SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM INTRODUCTION: Foreign body aspiration (FBA) is uncommon in healthy adults. An unexplainable chronic cough, recurrent pneumonia, or recurrent fevers may be clues that the patient has retained foreign body in the lung. In this case, we discuss a patient who presented with persistent pyrexia and right-sided pneumonia. CASE PRESENTATION: 73-year-old female diabetic presented with complaints of persistent fever, cough, and pleuritic chest pain for 6 weeks. She failed three courses of antibiotics, including one as an inpatient. Physical exam was significant for bilateral coarse breath sounds and right sided rhonchi. Labs showed persistent eosinophilia with a peak of 15.1%, not present on her prior admission. Chest X-Ray (CXR) and CT chest showed right lower lobe infiltrates and evidence of bronchial impactions. Considering her persistent symptoms, new development of eosinophilia, and resistance to broad spectrum antibiotics, a bronchoscopy was performed. Bronchoscopy showed an unexpected finding of what appeared to be a kernel of corn with adjacent granulation tissue in a segment of the RLL. BAL was remarkable for 25% eosinophilia. Remarkably, following removal of the foreign body, the patient’s fevers and eosinophilia immediately resolved. When the patient was informed of the unexpected finding, she recalled an episode of harsh coughing while eating popcorn nearly eight weeks prior. DISCUSSION: FBA in an otherwise healthy patient often presents subtly with chronic cough being present in 80% of cases1. Fever, hemoptysis, chest pain, foul smelling sputum, and eosinophilia may be present2. Partial or complete bronchial obstruction may potentially cause recurrent pneumonia, atelectasis, bronchiectasis, or lung abscess1. CXR and CT may show infiltrative processes, but are not good modalities for detecting aspirated organic materials3. Removal of the foreign body with a flexible or ridged bronchoscope is the mainstay of treatment1. CONCLUSIONS: FBA may subtly present in healthy adults and can mimic other respiratory disorders such as asthma, malignancy, or eosinophilic pneumonia. Clinicians should have a high index of suspicion in patients with symptoms such as unexplained cough, persistent fevers, or recurrent pneumonia. Bronchoscopy can be both diagnostic and therapeutic. Reference #1: Baharloo F, Veyckemans F, Francis C, Biettlot M, Rodenstein DO.“Tracheobronchial foreign bodies*: presentation and management in children and adults.” Chest 1999;115(5):1357-1362. Reference #2: Mukhopadhyay, S, and Katzenstein, A. “Pulmonary Disease Due to Aspiration of Food and Other Particulate Matter: A Clinicopathologic Study of 59 Cases Diagnosed on Biopsy or Resection Specimens.” The American Journal of Surgical Pathology (2007):752-59. Reference #3: Ciftci AO, Bingöl-Koloğlu M, Senocak ME, Tanyel FC, Büyükpamukçu N. “Bronchoscopy for evaluation of foreign body aspiration in children.” J Pediatr Surg. 2003;38 (8):1170. DISCLOSURE: The following authors have nothing to disclose: Omar Taha, Pavan Kumar Gorukanti, Mangalore Amith Shenoy, Karishma Kitchloo, Suchit Khanijao, Shyam Shankar, Animesh Gour, William Pascal, Michael Bergman No Product/Research Disclosure Information