Unrecognized Aspiration Pneumonia

Abstract

A man was admitted to a hospital with fever, productive cough, rhinitis, hiccups, tachypnea, elevated white blood count, and sputum gram stain showing gram-positive cocci, suggesting pneumonia. Rhinoscopy revealed decaying food in the posterior nares. After transfer to a major medical center he was noted to have had congenital hydrocephalus and to have had swallowing problems and regurgitation a week prior to hospitalization. Consideration of the detailed history and physical examination with attention to neurologic aspects suggested several small aspirations of gastric contents. A communicating hydrocephalus was treated with a ventriculo-atrial shunt. The left vocal cord was augmented with Teflon injection to balloon it to mid-line and prevent continued aspirations. Aspiration must be considered as a possible cause of any pneumonia, particularly when resolution is slow or the disease recurs.