Yoshida Norihito, Tanaka Tatsuki, Suzuki Yusuke, Ohashi Ryogo, Hitaka Mai, Ishii Shingo, Yamazaki Keisuke, Ohashi Yasushi
Division of Nephrology, Toho University Sakura Medical Center, Sakura, JPN.
Division of Pulmonology, Toho University Sakura Medical Center, Sakura, JPN.
Cureus. 2024 Dec 6;16(12):e75237. doi: 10.7759/cureus.75237. eCollection 2024 Dec.
Persistent hiccups are rare but can serve as an early symptom of underlying conditions, including pulmonary infections and cerebrovascular disorders. This case highlights hiccups as a presenting symptom of bronchopneumonia in a hemodialysis patient and explores the effective use of chlorpromazine and Hange-koboku-to (HKT) as symptomatic therapies. Given the potential association of hiccups with neurological conditions, this case underscores the need for comprehensive diagnostic evaluation. A 62-year-old man undergoing maintenance hemodialysis for end-stage renal disease presented with persistent hiccups lasting one week, accompanied by reduced oral intake. Imaging revealed ground-glass opacities in the right lower lobe and minimal bilateral pleural effusion. Sputum culture confirmed species, consistent with bronchopneumonia. Treatment included ampicillin/sulbactam (ABPC/SBT), azithromycin (AZM), chlorpromazine (37.5 mg/day, three times daily (t.i.d.)), and HKT (7.5 g/day, t.i.d.). Hiccups resolved within two days of initiating therapy, and both symptomatic treatments were discontinued by the fifth hospital day. At a two-week follow-up, the patient remained symptom-free with improved quality of life (QOL). This case demonstrates persistent hiccups as a potential early symptom of bronchopneumonia, likely caused by diaphragmatic irritation. Non-pharmacological interventions failed to provide relief, but a combination of chlorpromazine and HKT effectively alleviated symptoms. HKT, a traditional Kampo medicine, may modulate neurotransmitter pathways and serve as an adjunctive treatment for refractory hiccups. Furthermore, persistent hiccups in hemodialysis patients warrant careful evaluation to exclude central nervous system (CNS) disorders, including brainstem infarctions. These findings underscore the importance of recognizing atypical presentations of pneumonia and tailoring a multimodal therapeutic approach. Persistent hiccups require careful evaluation to rule out cerebrovascular events, but in this case, they were caused by bronchopneumonia. This report highlights hiccups as an early symptom of bronchopneumonia and demonstrates the efficacy of chlorpromazine and HKT as symptomatic treatments. Recognizing atypical presentations of respiratory infections and adopting targeted therapies are essential for effective management.
持续性呃逆虽罕见，但可作为包括肺部感染和脑血管疾病在内的潜在疾病的早期症状。本病例突出了呃逆作为一名血液透析患者支气管肺炎的首发症状，并探讨了氯丙嗪和半夏厚朴汤（HKT）作为对症治疗的有效应用。鉴于呃逆与神经系统疾病的潜在关联，本病例强调了全面诊断评估的必要性。一名因终末期肾病接受维持性血液透析的62岁男性出现持续呃逆一周，伴有口服摄入量减少。影像学检查显示右下叶磨玻璃样混浊和双侧少量胸腔积液。痰培养证实了菌种，符合支气管肺炎。治疗包括氨苄西林/舒巴坦（ABPC/SBT）、阿奇霉素（AZM）、氯丙嗪（37.5毫克/天，每日三次（t.i.d.））和HKT（7.5克/天，每日三次）。呃逆在开始治疗后两天内缓解，两种对症治疗在住院第五天停药。在两周的随访中，患者无症状，生活质量（QOL）得到改善。本病例表明持续性呃逆是支气管肺炎的潜在早期症状，可能由膈肌刺激引起。非药物干预未能缓解症状，但氯丙嗪和HKT联合使用有效缓解了症状。HKT作为一种传统的汉方药，可能调节神经递质途径，可作为难治性呃逆的辅助治疗。此外，血液透析患者的持续性呃逆需要仔细评估以排除中枢神经系统（CNS）疾病，包括脑干梗死。这些发现强调了认识肺炎非典型表现和制定多模式治疗方法的重要性。持续性呃逆需要仔细评估以排除脑血管事件，但在本病例中，它们是由支气管肺炎引起的。本报告强调呃逆是支气管肺炎的早期症状，并证明了氯丙嗪和HKT作为对症治疗的有效性。认识呼吸道感染的非典型表现并采用针对性治疗对于有效管理至关重要。
