His Hiccups Signaled a Life-Threatening Problem

A 55-year-old man sought help at a clinic for hiccups that had persisted for over two weeks, accompanied by a nonproductive cough and insomnia. Despite initial treatments like a short-acting beta-agonist inhaler, clarithromycin, and a traditional Japanese herb, his symptoms continued. Upon returning to the clinic, he was prescribed vonoprazan for probable gastroesophageal reflux disease, coupled with the muscle relaxant dantrolene.

His condition remained unchanged, prompting referral to the authors, who found no significant abnormalities during standard tests. However, an upper gastrointestinal endoscopy and contrast-enhanced CT scan revealed filling defects in both pulmonary arteries and thrombus formation in the right femoral vein. Diagnosed with deep vein thrombosis (DVT)-associated pulmonary embolism, he was immediately placed on direct oral anticoagulation.

His hiccups ceased within a week, and further tests for other clotting disorders were negative. The patient remains asymptomatic, with no recurrence of his hiccups. Emergency physician Lulu Wang highlighted the rarity of such cases and the importance of considering extended duration or accompanying symptoms when diagnosing hiccups.

Pulmonologist Zubair Hasan suggested that pulmonary embolism might have disrupted nerve signaling between the lungs and brain, triggering hiccups by irritating the vagus and phrenic nerves responsible for breathing and hiccup reflexes. He emphasized the need for clinicians to listen attentively to patient symptoms, as they can provide crucial information beyond what standard tests reveal.