# Forgotten Foreign Body Aspiration Presenting as Allergic Bronchopulmonary Aspergillosis: A Case Report

## TL;DR

A man with a long history of blood-stained sputum was found to have a forgotten plastic pen cap in his lung, initially mistaken for a fungal infection.

## Contribution

Highlights the diagnostic challenge of forgotten foreign body aspiration mimicking allergic bronchopulmonary aspergillosis.

## Key findings

- A 40-year-old male had a plastic pen cap in his lung for 20 years without immediate symptoms.
- The foreign body was initially misdiagnosed as allergic bronchopulmonary aspergillosis.
- Video bronchoscopy confirmed the presence and retrieved the foreign body.

## Abstract

The usual presentation of foreign body (FB) aspiration into the tracheobronchial tree is a choking sensation followed by recurrent respiratory symptoms. Without a definitive history, the diagnosis of FB aspiration can be challenging. Here, we present a case of a 40-year-old male who presented with recurrent episodes of blood-stained sputum over the past six years. Contrast-enhanced computed tomography of the chest and serological investigations suggested allergic bronchopulmonary aspergillosis. Video bronchoscopy was performed for the hemoptysis workup, which identified and retrieved a plastic pen cap from the right lower lobe bronchus. On questioning, the patient disclosed a history of FB aspiration 20 years ago. Because he did not develop any immediate symptoms, he assumed that he probably swallowed the FB and never divulged it.