Chronic Hiccups: Rare Allergy Diagnosis in Elderly Man

A decades-long medical mystery recently concluded with a surprising diagnosis for a 93-year-old man: his persistent, two-year-long bout of hiccups wasn’t a benign quirk, but a symptom of an underlying, treatable allergy. The case, detailed in a report published in the Journal of Medical Case Reports, highlights the importance of continued investigation even when symptoms seem inexplicable.

A Rare Presentation of a Common Reflex

Hiccups are involuntary contractions of the diaphragm, the muscle at the base of the lungs. These contractions create a characteristic sound, often described as a “held-back belch.” While typically harmless and temporary, often triggered by eating too quickly or consuming carbonated beverages, hiccups can become chronic and debilitating for some individuals. This was the case for the patient in question, who suffered from intermittent hiccups for over two years.

A Diagnostic Journey

The man had previously tried several medications to alleviate his hiccups, including baclofen (a muscle relaxant), chlorpromazine (an antipsychotic sometimes used for chronic hiccups), and proton pump inhibitors (used to treat acid reflux, which can sometimes cause hiccups). However, none provided lasting relief. His condition worsened in the two weeks leading up to his hospitalization, with incessant hiccups accompanied by significant fatigue.

Blood tests revealed an unusually high level of eosinophiles – white blood cells that typically increase in response to parasitic infections or allergic reactions. Specifically, the patient’s eosinophil count was 18%, significantly higher than the 1-4% typically found in healthy adults. Further investigation ruled out a parasitic infection, leading doctors to suspect a different cause.

Eosinophilic Esophagitis: An Unexpected Link

Doctors diagnosed the man with eosinophilic esophagitis (EoE), a condition characterized by an excessive buildup of eosinophiles in the esophagus. While EoE typically presents with difficulty swallowing, heartburn, and a sensation of food getting stuck, this patient exhibited none of those common symptoms, initially complicating the diagnosis. EoE can be triggered by common allergens, but the reaction is delayed compared to typical food allergies.

This case marks only the third documented instance of EoE manifesting primarily as chronic hiccups. Doctors believe the hiccups were likely caused by abnormal impulses sent from cells in the esophagus to the vagus nerve, a major nerve connecting the brain to the diaphragm.

Treatment and Resolution

The patient’s hiccups resolved after treatment with a combination of a proton pump inhibitor and baclofen, followed by a topical corticosteroid. This treatment successfully reduced his eosinophil levels and eliminated the persistent hiccups.

Frequently Asked Questions

What are eosinophiles?

Eosinophiles are a type of white blood cell that increase in number during infections and allergic reactions.

What is eosinophilic esophagitis?

Eosinophilic esophagitis (EoE) is a condition caused by a buildup of eosinophiles in the esophagus.

Can hiccups be a sign of a serious medical condition?

While most hiccups are harmless and temporary, persistent hiccups can sometimes indicate an underlying health problem, as demonstrated in this case.

Could this case lead to a broader awareness of atypical symptoms associated with eosinophilic esophagitis and encourage more comprehensive diagnostic evaluations for patients experiencing chronic hiccups?