Abstract
Persistent hiccups are rare but can serve as an early symptom of underlying conditions, including pulmonary infections and cerebrovascular disorders. This case highlights hiccups as a presenting symptom of bronchopneumonia in a hemodialysis patient and explores the effective use of chlorpromazine and Hange-koboku-to (HKT) as symptomatic therapies. Given the potential association of hiccups with neurological conditions, this case underscores the need for comprehensive diagnostic evaluation. A 62-year-old man undergoing maintenance hemodialysis for end-stage renal disease presented with persistent hiccups lasting one week, accompanied by reduced oral intake. Imaging revealed ground-glass opacities in the right lower lobe and minimal bilateral pleural effusion. Sputum culture confirmed Klebsiella species, consistent with bronchopneumonia. Treatment included ampicillin/sulbactam (ABPC/SBT), azithromycin (AZM), chlorpromazine (37.5 mg/day, three times daily (t.i.d.)), and HKT (7.5 g/day, t.i.d.). Hiccups resolved within two days of initiating therapy, and both symptomatic treatments were discontinued by the fifth hospital day. At a two-week follow-up, the patient remained symptom-free with improved quality of life (QOL). This case demonstrates persistent hiccups as a potential early symptom of bronchopneumonia, likely caused by diaphragmatic irritation. Non-pharmacological interventions failed to provide relief, but a combination of chlorpromazine and HKT effectively alleviated symptoms. HKT, a traditional Kampo medicine, may modulate neurotransmitter pathways and serve as an adjunctive treatment for refractory hiccups. Furthermore, persistent hiccups in hemodialysis patients warrant careful evaluation to exclude central nervous system (CNS) disorders, including brainstem infarctions. These findings underscore the importance of recognizing atypical presentations of pneumonia and tailoring a multimodal therapeutic approach. Persistent hiccups require careful evaluation to rule out cerebrovascular events, but in this case, they were caused by bronchopneumonia. This report highlights hiccups as an early symptom of bronchopneumonia and demonstrates the efficacy of chlorpromazine and HKT as symptomatic treatments. Recognizing atypical presentations of respiratory infections and adopting targeted therapies are essential for effective management.