Foreign body aspiration misdiagnosed as asthma - a case report and literature review

Abstract

Introduction Foreign body aspiration (FBA) is a rare but potentially life-threatening event occurring most commonly in children and older adults. The clinical presentation of occult FBA in adults is usually subtle, manifesting as chronic cough, wheezing, and exertional dyspnea. A delay in diagnosis is not uncommon for weeks or even months due to the subtle nature of the symptoms. Direct visualization via bronchoscopy continues to be the gold standard for diagnosing and treating FBA. In this report, we present a case of a man treated for five years for difficult-to-treat asthma with unnoticed tooth aspiration.

Case outline A 63-year-old non-smoker male patient was referred to the Clinic of Pulmonology, University Clinical Center of Serbia, with chief complaints of dyspnea and chronic cough over the course of five years. He sought medical help several times and was diagnosed and treated as late-onset bronchial asthma, which failed to improve even with optimized therapy. A high-resolution CT scan was performed, which showed a calcified body in the left main bronchus measuring 16 × 13 mm, which was later extracted via flexible bronchoscopy. There was immediate symptom relief after extraction. Pulmonary function tests after the procedure showed no bronchial obstruction, with a negative bronchodilator test.

Conclusion A difficult-to-manage asthma requires a thorough workup to rule out alternative diagnoses. Foreign body aspiration, even though a rare occurrence in adults without obvious risk factors, must be considered to prevent long-term complications.

Keywords: asthma; foreign body aspiration; bronchoscopy