Respircase Cilt: 6 - Sayı: 1 Yıl: 2017

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RESPIRATORY CASE REPORTS Respir Case Rep 2017;6(1):16-19 DOI: 10.5505/respircase.2017.87004 OLGU SUNUMU CASE REPORT An Aspiration of Cocklebur (Xanthium strumarium) Showing Impaired Swallowing Reflex in a Patient with Chronic Obstructive Pulmonary Disease KOAH'lı Bir Hastada Pıtrak Tohumu (Xanthium strumarium) Aspirasyonu Yutma Refleksinin Bozulduğunu Göstermektedir Hikmet Çoban, Adil Can Güngen, Yusuf Aydemir, Hasan Düzenli, Cahit Bilgin, Canatan Taşdemir Abstract A 64-year-old male patient who was under follow-up for chronic obstructive pulmonary disease (COPD) for 10 years was admitted with persistent cough for the past two years. Bronchoscopy due to atelectasis of the right lower lobe showed aspiration of common cocklebur (Xanthium strumarium). Herein, we present the dramatic case of COPD with accidental aspiration of a foreign body with spiny projections, which was large for the respiratory system and resulted in impaired swallowing reflex. Key words: COPD, swallowing reflex, common cocklebur. Özet Son iki yıldır geçmeyen öksürük şikâyeti olan kronik obstrultif akciğer hastalığı (KOAH) tanılı hastada, sağ alt zonda atelektazi izlenmesi üzerine yapılan bronkoskopide pıtrak tohumu (Xanthium strumarium) aspirasyonu tesbit edildi. Solunum sistemi için hacimce büyük, dikensi çıkıntıları olan bir yabancı cismi, hastanın farkında olmadan aspire etmesini, KOAH’lı hastalarda yutma refleksindeki bozulmayı gösteren, dramatik bir örnek olduğu için sunuyoruz. Anahtar Sözcükler: KOAH, yutma refleksi, bıtrak tohumu. Foreign body aspirations usually occur in children. In adults, it is often associated with impairment of the swallowing reflex in conditions such as mental retardation, neurological disorders, and loss of consciousness. It has been demonstrated that swallowing reflex is impaired in patients with chronic obstructive pulmonary disease (COPD), which may lead lo aspirations and exacerbations eventually. Herein, we present an interesting case of aspiration with COPD. Department of Chest Diseases, Ministry of Health Sakarya University Medical School Training and Research Hospital, Sakarya, Turkey Sağlık Bakanlığı Sakarya Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Kliniği, Sakarya Submitted (Başvuru tarihi): 05.05.2016 Accepted (Kabul tarihi): 15.08.2016 Correspondence (İletişim): Hikmet Çoban, Department of Chest Diseases, Ministry of Health Sakarya University Medical School Training and Research Hospital, Sakarya, Turkey e-mail: hikmetcoban04@gmail.com 16
Respiratory Case Reports CASE A 64-year-old male patient who was followed for COPD for 10 years presented with a complaint of severe cough persisting even during stable periods of his condition for the past two years. During follow-up, his complaint of cough was attributed to his present condition and he had an episode of hospitalization. Being an ex-smoker for five years, he had a 50 pack/year history of smoking with purulent sputum without hemoptysis. He had no comorbidities. Pulmonary function test showed a forced vital capacity (FVC) of 2500mL (66%), a forced expiratory volume in 1 second (FEV1) of 1330mL (46%), and a FEV1/FVC ratio of 46%. Auscultation revealed diminished breath sounds with a prolonged expirium, and thin rales in the right base, while the results of other system examinations were normal. A chest X-ray showed a homogeneous area in the right lower lobe (Figure 1). The diaphragm contour was elevated in the right side secondary to atelectasis. Blood count values were normal with a C- reactive protein (CRP) level of 25.6 mg/L. Thoracic CT showed a lesion blocking the right intermediate bronchus. Atelectasis and post-obstructive area of pneumonic consolidation were observed in the periphery of the lesion (Figures 2 and 3). Bronchoscopy showed an almost completely occluded right intermediate bronchus. The lesion included radial projections (Figure 4). The lesion was detached using forceps to avoid any complication relating to the foreign body. A plenty of purulent secretion was aspirated from the lesion. By retracting it toward the proximal from its current position, the body was re-grasped by forceps and removed by bronchoscopy. After removal of the lesion, it was found out that it was a cocklebur (Xanthium strumarium) (Figure 5). A complete recovery was achieved in post-obstructive pneumonia by oral antibiotic therapy. The evaluation of swallowing was performed by gag (pharyngeal reflex) reflex. The soft palate and posterior pharyngeal wall were stimulated and a decrease in the elevation and contraction of the pharyngeal muscles was observed. The test result was evaluated decreased gag reflex. The swallowing reflex occurs in two dynamic and complex phases. At the time when a food is swallowed, there occurs a pause in breathing for a few seconds, and the breath returns in the expiratory phase, thereby avoiding aspiration (1). In cases where the relationship between breathing and swallowing reflex is disturbed, the risk of aspiration increases (2-4). Patients with COPD may develop abnormalities in swallowing reflex due to dyspnea and impaired thoraco-abdominal biomechanics, as these patients do not have the respiratory pause required in the normal swallowing process (5). The impaired swallowing leads to micro-aspiration, which may be a potential risk factor for COPD exacerbation (6). Figure 1: An increased density in the right lower lobe and impairment and deletion in the right diaphragm contour are observed Figure 2: A lesion blocking the right intermediate bronchus is observed DISCUSSION Figure 3: A lesion blocking the right intermediate bronchus is observed Cilt - Vol. 6 Sayı - No. 1 17
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