Moroccan doctors report the case of a 43-year-old patient hospitalized for the management of pulmonary abscess complicated by severe infection. This clinical observation was published in the October 2019 issue of the Journal of Respiratory Diseases .
The story of this man's illness goes back 23 years. That day, he is in the middle of the day and inadvertently inhales what he thinks is a cloud of dust. He is then seized with a coughing fit which disappears after a few hours. While he later presents a moderate fever and a cough fat, the patient does not consult at the time.
Later, pulmonary auscultation reveals a hissing sound, especially during the winter season. This causes the patient to be treated for asthma without clinical improvement. This man will then present many recurrent infections (8 episodes per year) treated with antibiotics. Insidious symptomatology develops, characterized by relapses and remissions until the day when the state of health deteriorates, with weight loss of 7 kg in one month. The patient has severe infectious signs (sepsis) with rapid breathing and fever at 39 ° C. He is hospitalized in pneumology. Medical imaging (chest x-ray and thoracic CT scan) shows an isolated lesion in the right lung (middle lobe) measuring 9 cm x 6 cm. Blood tests indicate an inflammatory syndrome.
The patient is put on antibiotic therapy then benefit from intensive respiratory physiotherapy. Ten days later, the fever has subsided and sputum clarification is observed.
A chest CT scan shows the presence of a nail in the right lung. It is embedded in a bronchus (intermediate trunk). Surrounded by a purulent area, the foreign body completely obstructs the respiratory tract. The nail is extracted during an endoscopic exploration of the bronchi (rigid bronchoscopy).
Subsequently, the patient is treated with antibiotics and corticosteroids for one week, which normalizes pulmonary imaging and clinical status.
The diagnosis of foreign intra-bronchial body is rarely evoked in adults, say the surgeons of the University Hospital Mohammed VI (Oujda). Therefore, "long misunderstood or neglected, the diagnosis of inhaling an EC may be late and prove to be a complication."
In 2008, Japanese doctors described the case of a 30-year-old man with treatment-refractory pneumonia who was ultimately responsible for a neglected bronchial foreign body for 25 years. In 1969, an Italian team reported the longest bronchial foreign body retention in an adult: 55 years old.
According to the Moroccan authors, it is necessary to evoke the possible presence of a foreign intra-bronchial body in front of the persistence of unexplained chronic respiratory problems. And to conclude: "Early diagnosis and management would prevent progression to potentially serious complications."
Marc Gozlan (Follow me on Twitter , on Facebook )
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To know more :
Marouf R, Hamraoui S, Alloubi I. A neglected bronchial foreign body for 23 years. Rev Mal Respir. 2019 Oct; 36 (8): 1002-1007. doi: 10.1016 / j.rmr.2019.06.010
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