Abstract Introduction Chronic cough is a frequent but often challenging symptom, with diverse etiologies ranging from asthma, postnasal drip, and gastroesophageal reflux to rare mechanical causes. Foreign body aspiration (FBA) in adults is uncommon and easily overlooked, particularly when the aspiration event is unrecognized. This case highlights a rare presentation of chronic cough secondary to a retained bronchial foreign body, successfully managed in a resource-limited setting. Case Report A 52-year-old female with a medical history of asthma, hypertension, hyperlipidemia, and diabetes mellitus presented to the outpatient pulmonary clinic with a persistent nonproductive cough lasting over one year. The cough was refractory to multiple therapeutic regimens, including proton pump inhibitors, antibiotics, corticosteroids, and bronchodilators. She denied a history of autoimmune disease or prior COVID-19 infection. Physical examination revealed stable vital signs and no acute respiratory distress. Review of a chest CT obtained one year earlier incidentally revealed a foreign body in the right lower respiratory tract, initially presumed to be a metallic nose ring that the patient had reported missing. A repeat CT scan demonstrated a 12 × 9 mm foreign body within the bronchus intermedius, resulting in complete collapse of the right middle lobe and partial atelectasis of the right lower lobe. Due to the object’s size and the resource-limited setting, the patient underwent flexible bronchoscopy for retrieval of the foreign body using rat-tooth forceps. The object could not be removed through the endotracheal tube, so the patient required extubation with the foreign body attached to both the forceps and the endotracheal tube, followed by reintubation for airway protection. A chicken bone was successfully removed from the bronchus intermedius. Granulation tissue was observed at the site and biopsied using blunt forceps. Pathologic examination revealed benign bronchial mucosa with chronic inflammation and focal atypical squamous metaplasia. Minor bleeding was controlled with cold saline and diluted epinephrine. A post-procedure chest X-ray confirmed full lung expansion without pneumothorax. Discussion Foreign body aspiration should remain a consideration in adults with chronic cough unresponsive to conventional therapy, even in those with preexisting respiratory conditions and without identifiable risk factors for aspiration. This case emphasizes the importance of clinical vigilance, detailed history review, and reevaluation of imaging studies. Even in resource-limited settings, timely recognition and intervention can lead to full recovery and prevention of further complications. This abstract is funded by: None
Said et al. (Fri,) studied this question.