AN OVERLOOKED TRACHEOBRONCHIAL FOREIGN BODY IN AN IMMUNOCOMPROMISED UNRESPONSIVE PATIENT

Abstract

Tracheobronchial foreign body (TFB) aspiration is a rare but serious event in adults, often missed due to atypical or nonspecific presentations. We report the case of a 67-year-old male with multiple comorbidities including HIV, hepatitis B, type 2 diabetes mellitus (DM-2), and hypertension (HTN), who was brought to the emergency room in an unconscious state and found to have severe hypoglycaemia. Despite prompt correction, his Glasgow Coma Scale (GCS) did not improve, requiring endotracheal intubation and mechanical ventilation. During his ICU stay, he developed a right-sided pneumothorax on day 3, presumed to be barotrauma-related and managed with an intercostal drain (ICD). Subsequently, the patient developed left lung collapse, prompting flexible bronchoscopy, which revealed a large, previously overlooked intrabronchial foreign body. This foreign body, likely aspirated during his initial unconscious state, was the actual underlying cause of both the right pneumothorax—due to a ball-valve mechanism—and the later left lung collapse following its migration. This case underscores the importance of early suspicion of TFB aspiration in critically ill, neurologically compromised adults, especially in the absence of clear history.