oa Atypical presentation of achalasia cardia: A case report

Background: Primary achalasia is a disease of unknown etiology in which there is a loss of peristalsis in the distal esophagus and a failure of lower esophageal sphincter to relax with swallowing. Typical Clinical manifestations including dysphagia for solids (91%) and liquids (85%) and regurgitation food (76 to 91%) are the most frequent symptoms in patients with achalasia. Regurgitation may also result in aspiration (8%). However, atypical presentation of achalasia may cause delayed diagnosis and mismanagement.

Objective: This case report presents atypical presentation of achalasia in which patients presenting primarily with prolonged cough. This case report discusses possible mechanisms explaining the atypical presentation of achalasia including chronic cough.

Methods: We report a 45-year-old female patient presented to Emergency Department at Al Wakra Hospital with a history of cough and shortness of breath for more than two weeks. Oxygen saturation was 90% on room air with no history of vomiting, fever, hemoptysis, hematemesis or weight loss. Additionally, there was no significant past medical history except for recent diagnosis with bronchial asthma. In ED, patient was managed as a case of bronchial asthma exacerbation and received beta-2 agonist nebulization, intravenous corticosteroid and oxygen mask. Minimal improvement in the her condition was noted after treatment. Initial investigations were conducted including complete blood count, comprehensive metabolic panel and chest X-Ray. A radiolucent space in upper mediastinum with a query of pneumomediastinum was determined. Further imaging was conducted using computed tomography which showed diffuse dilatation of the esophagus.

Conclusion: Chronic cough could be the only presentation in achalasia cardia.This a typical presentation may cause misdiagnosis or delayed treatment and should be considered in differential diagnosis.