Eleven-Year Undiagnosed Bronchial Foreign Body in an Adult: A Case Report

Foreign body aspiration (FBA) in adults is rare, and tooth aspiration represents an exceptionally uncommon subset. Even rarer is the prolonged retention of a tooth in the left main bronchus, which is anatomically less favorable for aspiration than the right. However, individual airway variations may predispose to such occurrences. We report the case of a 56-year-old woman with an 11-year history of recurrent "pneumonia-like" episodes characterized by chronic productive cough, intermittent fever, hemoptysis, and pleuritic chest pain. She had been repeatedly treated with empirical antibiotic regimens - including azithromycin, amoxicillin-clavulanate, and levofloxacin - and intermittent corticosteroids, resulting in only transient symptomatic relief. Subsequently, she developed recurrent profuse watery diarrhea following prolonged antibiotic exposure, initially managed with oral metronidazole but complicated by recurrence and eventual toxic megacolon secondary to severe Clostridioides difficile colitis. She was referred to our tertiary care center for possible surgical intervention and was successfully managed conservatively with oral vancomycin and intravenous metronidazole. During hospitalization, further evaluation of her chronic respiratory symptoms with CT and bronchoscopy revealed a retained incisor lodged in the left main bronchus. Flexible bronchoscopy was unsuccessful because of dense impaction and bleeding; however, definitive extraction was achieved using rigid bronchoscopy under general anesthesia. Post-procedure recovery was uneventful, and six-month follow-up demonstrated complete clinical and radiologic resolution. This case highlights the importance of considering FBA in adults with chronic, unexplained pulmonary symptoms, the potential consequences of repeated empirical antibiotic therapy - particularly in resource-limited settings - and the critical role of rigid bronchoscopy in definitive management.