Prolonged Hiccups in Man Linked to Unusual Allergy Syndrome Lasting Nearly Two Years
Get the down-low on a persistent hiccup case. A bizarre medical saga unfolded when doctors in Lebanon encountered an older chap plagued with incessant hiccups, stemming from an obscure allergy issue.
Yeah, the paper went public in the Journal of Medical Case Reports this month. The guy had been tormented by these hiccups for years, with no let-up. Initially checked into the hospital due to exhaustion and endless hiccups, the docs were stumped about what was driving this odd medical mystery.
They tried various medications to curb the hiccup fits, from muscle relaxants and antipsychotics to proton-pump inhibitors (for acid reflux, which can trigger chronic hiccups). But nothing provided relief. When the hiccups persisted for an extended two-week stint, it was time for some serious intervention.
A blood test revealed this guy had a sky-high number of eosinophils, those white blood cells helping fight off parasites. Normally they make up just 1-4% of our white blood cells, but this chap had an alarming 18%. Eosinophils also occur in allergy-related conditions, so docs suspected an allergic trigger was at play. But there were no indications of a parasitic infestation.
Digging further, they found the gentleman had eosinophilic esophagitis (EoE), caused by too many eosinophils building up in the esophagus (this can strike elsewhere, too). Typically, EoE develops in response to common allergens, but the immune response is different from regular food allergies. Symptoms appear late rather than instantly, not like with a classic peanut allergy. Estimates suggest around half a million Americans wrestle with EoE, though cases are on the rise.
This tale takes an unusual turn given the man's hiccups. Normal EoE symptoms include swallowing troubles, heartburn, and food getting stuck. The man displayed none of these. His EoE condition also surfaced at an older age than usual, with diagnoses typically found in youngsters or those in their 30s and 40s.
The doctors hunted the medical literature for similar cases and found just two suspected EoE instances causing chronic hiccups. Possibly, his EoE triggered nerve signals to the vagus nerve (vital for diaphragm communication), leading to the hiccup fits.
In this case, the good news is the story has a bright ending. Initially, the combo of a proton-pump inhibitor with baclofen only slightly improved the hiccups. But shifting to a topical steroid took care of the issue in a week, and his eosinophil count returned to healthy levels.
The docs conclude this is a lesson: EoE can sometimes manifest in unexpected ways, even if typical symptoms are absent. And prompt treatment with topical steroids could be the key for folks wrestling with chronic, refractory hiccups.
- The case of the elderly man with incessant hiccups due to an obscure allergy issue was reported in the Journal of Medical Case Reports this month.
- During his hospital stay, the man's high number of eosinophils, a type of white blood cell associated with allergy-related conditions, was found to be the culprit for his chronic hiccups.
- Upon further investigation, it was revealed that the man had eosinophilic esophagitis (EoE), a condition where too many eosinophils build up in the esophagus, and this was causing his hiccups, despite his lack of common EoE symptoms.
- The doctors' conclusion from this case is that EoE has the potential to manifest in unexpected ways, particularly in the elderly, and treating it promptly with topical steroids could be key in resolving refractory, chronic hiccups.
