UNMASKING CHRONIC COUGH AND ASTHMA: THE SILENT BODY

Abstract

SESSION TITLE: Fellows Allergy and Airway Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Foreign body aspiration is an emergency situation which requires early bronchoscopy. Most of the patients will recall the event, however it could be a surprising finding in bronchoscopy procedures. Symptoms include shortness of breath, fever, and hemoptysis. In this case, it presents as chronic cough with uncontrolled asthma for several years despite optimized therapy. CASE PRESENTATION: Case of a 52-year-old man with past medical history of GERD, partly controlled severe asthma and chronic persistent cough who presented with bloody sputum without shortness of breath, chest pain or palpitation. Initial evaluation at ER with evidence of right lower lobe infiltrate and was admitted for treatment of pneumonia. He also recognized recurrent episodes of bronchitis, and fever episodes in the last 48 hours. He presented 3 months prior to admission to the emergency department with cough and subjective fever, by which had a chest x ray showing linear and patchy densities at the right lung base, azithromycin was prescribed and discharge home respectively. On examination, vital signs were stable. Chest auscultation revealed mildly decreased breath sounds and rhonchi in the right lower lung field. Chest transverse axial computer tomography with a right basilar lung consolidation with air bronchograms and hyperdense filling defect in the right lower lobe bronchus. Chest computer tomography 3 year prior to admission had evidence of right sided infiltrate believe to be secondary to pneumonia that was treated at that time. In view of hemoptysis and persistent right lower lobe infiltrate a flexible bronchoscopy was performed that revealed significant erythema with a foreign body visualized in the right lower lobe with associated granulation tissue . Subsequent evaluation visits with improved chronic cough and asthma respectively after the successful retrieval. DISCUSSION: Foreign bodies may result in serious complications if left unrecognized. This complication includes recurrent pneumonia, lung abscess, bronchopleuralcutaneus fistulas, atelectasis, and bronchiectasis with mucus impaction . However, in the case of chronic aspiration, bronchoscopy may show features of tissue reaction to the foreign body, by which object could be found incarcerated and difficult to be seen. Granulation reactions could eventually lead to airway strictures, and subsequently airway distortion, by which could present with unilateral wheezes in physical examination. Its important to note that bronchoscopy is present in chronic cough management algorithm. CONCLUSIONS: Chronic cough and persistent asthma that does not respond to standard therapy is the key to suggest a foreign body aspiration. Chronic cough is the most common symptom and is present in two-thirds of patients with foreign body aspiration. For that purpose, it’s important an early suspicion for a successful detection and a subsequent improvement of symptoms. Reference #1: Irwin RS, Madison JM. The diagnosis and treatment of cough. N Engl J Med. 2000;343:1715–21. Reference #2: Irwin RS, Boulet LP, Cloutier MM, Fuller R, Gold PM, Hoffstein, et al. Managing cough as a defense mechanism and as a symptom. A consensus panel report to the American College of Chest Physicians. Chest. 1998;114(2 suppl):133–81S. Reference #3: Al-Majed SA, Ashour M, Al-Mobeireek AF, Al-Hajjaj MS, Alzeer AH, Al-Kattan K. Overlooked inhaled foreign bodies: late sequelae and the likelihood of recovery. Respiratory Medicine. 1997;91(5):293–296. DISCLOSURES: No relevant relationships by Christian Castillo Latorre, source=Web Response No relevant relationships by Ilean Lamboy, source=Web Response No relevant relationships by Mariana Mercader-Pérez, source=Web Response No relevant relationships by William Rodriguez-Cintron, source=Web Response No relevant relationships by Jose Torres-Palacios, source=Web Response