Journal of Global Infectious Diseases

LETTER TO EDITOR
Year
: 2013  |  Volume : 5  |  Issue : 2  |  Page : 88-

Intractable hiccups in an elderly diabetic: An unusual presentation of ascaris lumbricoides


Ramesh Aggarwal1, Shridhar Dwivedi1, Anupam Dey1, Shamim Ullah Khan1, Meenakshi Aggarwal2,  
1 Department of Medicine/Preventive Cardiology, Hamdard Institute of Medical Sciences and Research and HAH Centenary Hospital, Jamia Hamdard, Hamdard University, New Delhi, India
2 Department of Microbiology, CNBC and Associated Maulana Azad Medical College, New Delhi, India

Correspondence Address:
Ramesh Aggarwal
Department of Medicine/Preventive Cardiology, Hamdard Institute of Medical Sciences and Research and HAH Centenary Hospital, Jamia Hamdard, Hamdard University, New Delhi
India




How to cite this article:
Aggarwal R, Dwivedi S, Dey A, Khan SU, Aggarwal M. Intractable hiccups in an elderly diabetic: An unusual presentation of ascaris lumbricoides.J Global Infect Dis 2013;5:88-88


How to cite this URL:
Aggarwal R, Dwivedi S, Dey A, Khan SU, Aggarwal M. Intractable hiccups in an elderly diabetic: An unusual presentation of ascaris lumbricoides. J Global Infect Dis [serial online] 2013 [cited 2021 Dec 2 ];5:88-88
Available from: https://www.jgid.org/text.asp?2013/5/2/88/112287


Full Text

Sir,

India is considered to be the diabetic capital of the world. [1] Hiccups persisting for more than one week in a diabetic patient are not that common and are difficult to treat. A 50-year-old male chronic tobacco user with uncontrolled diabetes, hypertension, and diabetic foot presented with hiccups for the last 10 days. His left leg was amputated about 22 years back in an accident; it was at this time that he was also diagnosed to be diabetic. His blood investigations including kidney functions were normal except high blood sugars. He did not respond to any of our symptomatic treatment for hiccups till he expectorated a round worm [Figure 1] and got relieved. Although the exact mechanism by which worms cause hiccups is not mentioned in literature, it may be because of the irritation of vagus or phrenic nerve or gastroesophageal reflux. [2],[3],[4]{Figure 1}

This case highlights important epidemiological aspects of our country along with an equally interesting clinical presentation. Here is the phenomenon of "triple whammy," that is a non-communicable disease like diabetes occurring at a comparatively young age of 28 with its attendant complication like diabetic foot in an individual who already is a below knee amputee. Despite suffering from these complications of diabetes he continues to smoke and suffers with a communicable disease like Ascariasis. Ascariasis may remain asymptomatic for a long period, [5] only to be diagnosed when an individual either vomits out or coughs out or passess the adult worms in stool. But in our case it produced hiccups and the diagnosis could only be made once the patient vomited it and hiccups stopped completely with the expulsion. of the worm. Present case also tells us the importance of inspection at the bed side, [6],[7] a round worm in vomitus giving clue to the intractable hiccup.

 Acknowledgment



The assistance provided by Dr. Mohammad Sadique, BUMS Intern, Hamdard University, is gratefully acknowledged.

References

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3Lipsky MS. Chronic hiccups. Am Fam Physician 1986;34:173-7.
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5Clinch CR, Stephens MB. Case description of ascariasis. Arch Fam Med 2000;9:1193-4.
6Grais IM. Bedside skills: A 50-year personal retrospective. Tex Heart Inst J 2010;37:629-32.
7Fred HL. Hyposkillia: Deficiency of clinical skills. Tex Heart Inst J 2005;32:255-7.