AN UNCOMMON CAUSE OF HICCUP: SARCOIDOSIS

A 28 year-old male presented with hiccup of 2 months duration. His physical examination was unremarkable. Laboratory investigations revealed elevated angiotensin converting enzyme (ACE) levels. Chest radiography revealed bilateral infiltrations and hilar enlargements. Thorax computed tomography (CT) revealed enlarged mediastina lymph nodes and bilateral reticulonodular densities distributed more densely in the upper lung fields. Bronchoscopy was performed and non-caseating granuloma was determined in pathologic examination. Bronchoalveolar lavage cultures for tuberculosis and fungal infections were negative. We diagnosed patient as sarcoidosis due to mediastinal lymph node enlargement, non-caseating granuloma, exclusion of tuberculosis and fungal infections and elevated serum ACE level. Magnetic resonance imaging of brain revealed well-circumscribed lesion on the dorsal side of medulla. We conclude that the long-standing hiccup may be due to enlarged mediastina lymph node and/or neurosarcoidosis. Therefore physicians should keep in mind the diagnosis of sarcoidosis in patients presenting with hiccup.