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LETTER TO EDITOR  
Year : 2013  |  Volume : 5  |  Issue : 2  |  Page : 88
Intractable hiccups in an elderly diabetic: An unusual presentation of ascaris lumbricoides


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

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Date of Web Publication20-May-2013
 

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

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 2020 Nov 26];5:88. Available from: https://www.jgid.org/text.asp?2013/5/2/88/112287


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: Ascaris lumbricoides vomited out

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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 Top


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

 
   References Top

1.Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217-30.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Chang FY, Lu CL. Hiccup: Mystery, nature and treatment. J Neurogastroenterol Motil 2012;18:123-30.  Back to cited text no. 2
    
3.Lipsky MS. Chronic hiccups. Am Fam Physician 1986;34:173-7.  Back to cited text no. 3
    
4.Woelk CJ. Managing hiccups. Can Fam Physician 2011;57:672-5.  Back to cited text no. 4
    
5.Clinch CR, Stephens MB. Case description of ascariasis. Arch Fam Med 2000;9:1193-4.  Back to cited text no. 5
    
6.Grais IM. Bedside skills: A 50-year personal retrospective. Tex Heart Inst J 2010;37:629-32.  Back to cited text no. 6
    
7.Fred HL. Hyposkillia: Deficiency of clinical skills. Tex Heart Inst J 2005;32:255-7.  Back to cited text no. 7
    

Top
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
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.112287

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