The Clinical Respiratory Journal LETTER TO THE EDITOR
Recurrent pneumonia due to olive aspiration in a healthy adult: a case report
Foreign body aspiration (FBA) of healthy adults is an extremely unusual condition due to functional swallowing reflex. It may be seen more common in patients who have primary underlying causes such as neurological diseases, mental retardation, alcohol or sedative misuse. FBA in adults can be difficult to diagnose because the symptoms are nonspecific and chest X-rays may be normal. Occult FBA may lead to a mistaken clinical diagnosis of asthma, bronchitis, chronic pneumonia, recurrent pneumonia and bronchiectasis (1, 2). In Turkey, olive consumption at breakfast is very common particularly among adults. We presented a case of olive aspiration which is extremely rare. A 64-year-old female adult patient was admitted to our clinic with a 1-week history of fever, productive
cough and shortness of breath. Vital signs on admission revealed a pulse of 80 beats/min, blood pressure of 120/80 mmHg, respiratory rate of 14 breaths/min and a temperature of 37.5°C. Chest examination revealed crackles on the right lower area. The rest of the systemic examination was unremarkable. Chest X-ray revealed pneumonic infiltrates in the right middle and lower lung zones. The laboratory tests on admission showed a leucocyte count of 12 300/μL (4.0–10/μL) with 72% neutrophils. C-reactive protein was at 18 μmol/L (0–0.5 mg/dL). She was diagnosed with community acquired pneumonia involving the right lower lobe and parenteral antibiotic therapy was initiated. As learned from the patient medical history, she had been hospitalized because of right lower lobe pneumonia
Figure 1. Computed tomography scan of the chest showed foreign body in the intermediar bronchus and consolidation in the right lower lobe.
Figure 2. The foreign body in the intermediate bronchus was detected by flexible bronchoscope and successfully removed via rigid bronchoscope.
The Clinical Respiratory Journal (2015) • ISSN 1752-6981 © 2015 John Wiley & Sons Ltd
1
Letter to the editor
3 months ago. Pneumonia had been resolved without any complication. Computed tomography scan of the chest revealed typical appearance of a foreign body in the intermediate bronchus which has a hyperdense zone around the hypodense central zone and consolidation in the right lower lobe (Fig. 1). Our patient had no risk factors for aspiration and she was not aware about this condition. The foreign body in the intermediate bronchus was successfully removed via rigid bronchoscope (Fig. 2). The patient was discharged home with almost complete resolution of her symptoms and was well in subsequent clinic visits after removal of the foreign body. In this case, occult olive aspiration lead to recurrent pneumonia. To our knowledge, this is the first case report of a recurrent pneumonia because of olive aspiration in a healthy adult.
2
Akgedik et al.
Recep Akgedik1, Ilknur Aytekin2, Ali Bekir Kurt3 and Canan Eren Dag˘lı1 1 Chest Disease, Ordu University, Ordu, Turkey 2 Thoracic Surgery, Gaziantep University, Gaziantep, Turkey 3 Radiology, Ordu University, Ordu, Turkey
References 1. Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest. 1999;115(5): 1357–62. 2. Bain A, Barthos A, Hoffstein V, Batt J. Foreign-body aspiration in the adult: presentation and management. Can Respir J. 2013;20(6): 98–9.
The Clinical Respiratory Journal (2015) • ISSN 1752-6981 © 2015 John Wiley & Sons Ltd
Recurrent pneumonia due to olive aspiration in a healthy adult: a case report
Foreign body aspiration (FBA) of healthy adults is an extremely unusual condition due to functional swallowing reflex. It may be seen more common in patients who have primary underlying causes such as neurological diseases, mental retardation, alcohol or sedative misuse. FBA in adults can be difficult to diagnose because the symptoms are nonspecific and chest X-rays may be normal. Occult FBA may lead to a mistaken clinical diagnosis of asthma, bronchitis, chronic pneumonia, recurrent pneumonia and bronchiectasis (1, 2). In Turkey, olive consumption at breakfast is very common particularly among adults. We presented a case of olive aspiration which is extremely rare. A 64-year-old female adult patient was admitted to our clinic with a 1-week history of fever, productive
cough and shortness of breath. Vital signs on admission revealed a pulse of 80 beats/min, blood pressure of 120/80 mmHg, respiratory rate of 14 breaths/min and a temperature of 37.5°C. Chest examination revealed crackles on the right lower area. The rest of the systemic examination was unremarkable. Chest X-ray revealed pneumonic infiltrates in the right middle and lower lung zones. The laboratory tests on admission showed a leucocyte count of 12 300/μL (4.0–10/μL) with 72% neutrophils. C-reactive protein was at 18 μmol/L (0–0.5 mg/dL). She was diagnosed with community acquired pneumonia involving the right lower lobe and parenteral antibiotic therapy was initiated. As learned from the patient medical history, she had been hospitalized because of right lower lobe pneumonia
Figure 1. Computed tomography scan of the chest showed foreign body in the intermediar bronchus and consolidation in the right lower lobe.
Figure 2. The foreign body in the intermediate bronchus was detected by flexible bronchoscope and successfully removed via rigid bronchoscope.
The Clinical Respiratory Journal (2015) • ISSN 1752-6981 © 2015 John Wiley & Sons Ltd
1
Letter to the editor
3 months ago. Pneumonia had been resolved without any complication. Computed tomography scan of the chest revealed typical appearance of a foreign body in the intermediate bronchus which has a hyperdense zone around the hypodense central zone and consolidation in the right lower lobe (Fig. 1). Our patient had no risk factors for aspiration and she was not aware about this condition. The foreign body in the intermediate bronchus was successfully removed via rigid bronchoscope (Fig. 2). The patient was discharged home with almost complete resolution of her symptoms and was well in subsequent clinic visits after removal of the foreign body. In this case, occult olive aspiration lead to recurrent pneumonia. To our knowledge, this is the first case report of a recurrent pneumonia because of olive aspiration in a healthy adult.
2
Akgedik et al.
Recep Akgedik1, Ilknur Aytekin2, Ali Bekir Kurt3 and Canan Eren Dag˘lı1 1 Chest Disease, Ordu University, Ordu, Turkey 2 Thoracic Surgery, Gaziantep University, Gaziantep, Turkey 3 Radiology, Ordu University, Ordu, Turkey
References 1. Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest. 1999;115(5): 1357–62. 2. Bain A, Barthos A, Hoffstein V, Batt J. Foreign-body aspiration in the adult: presentation and management. Can Respir J. 2013;20(6): 98–9.
The Clinical Respiratory Journal (2015) • ISSN 1752-6981 © 2015 John Wiley & Sons Ltd
