A Patient with Abnormal Eating Behavior Who Aspirated a Foreign Body

Abstract

Background. Patients with mental disorders are likely to aspirate various objects and the characteristics vary, but the removal of material aspirated due to abnormal eating behavior by bronchoscopy has rarely been reported. Case Presentation. The patient was a 52-year-old man attending a hospital for schizophrenia. Bloody sputum was noted upon coughing during eating, and the patient visited the outpatient clinic of our hospital. Rales were heard in the right chest, and stenosis was noted in the orifice of the right upper pulmonary lobe on chest CT, for which bronchoscopy was performed. The orifice of the right upper lobe was narrowed, a foreign body was present in the airway, and it was removed using biopsy forceps. On histological examination of the foreign body, actinomycetes adhered to its surface and a few inflammatory cells were present. Squamous metaplasia was observed in the surrounding bronchial mucosa. It was subsequently clarified by an interview that he had experienced an episode of aspiration during eating 2 weeks before the episode of bloody sputum, and wheezing had appeared since then. The wheezing resolved after bronchoscopy, and stenosis in the bronchial orifice improved. His speech therapist observed abnormal eating behavior as the cause of aspiration. Conclusion. Aspiration occurred due to abnormal eating behavior. It is important to rapidly perform bronchoscopy when aspiration is suspected based on an interview and examination. Attention should be paid to the fact that aspiration occurs due to abnormal eating behavior, which is a neurologic manifestation in patients with schizophrenia, in addition to swallowing disorder.