When pneumonia doesn't heal: A hidden diagnosis and a life turned around at NMC Royal Hospital, DIP

Khaleej Times

17-07-2025

When weeks of antibiotics failed to help a Dubai resident's chronic cough, doctors at NMC Royal Hospital, DIP, uncovered the real culprit — fragments of cashew nuts lodged in his lung
A 43-year-old man living with poorly controlled diabetes was admitted to NMC Royal Hospital, Dubai Investment Park (DIP), with a persistent cough and shortness of breath that had lingered for weeks despite multiple courses of antibiotics.
Initially diagnosed with pneumonia, his condition showed minimal improvement, prompting the hospital's medical team to investigate further.
A detailed CT scan of the chest revealed a partial lung collapse in the lower lobe of his right lung, raising concerns about a possible blockage in the airway.
He was promptly referred to Dr Gopal Chawla, specialist pulmonologist at NMC Royal Hospital, DIP, for further evaluation.
Dr Chawla performed a flexible bronchoscopy – a simple, minimally invasive procedure that involves passing a thin, flexible camera through the mouth into the lungs to identify any internal obstructions.
To the team's surprise, the bronchoscopy revealed two cream-colored foreign bodies lodged deep in the patient's airways. Surrounded by inflamed tissue and granulation, the fragments were identified as cashew nuts likely inhaled unknowingly during a meal.
The patient had no memory of choking or difficulty swallowing, yet the nuts had somehow entered the lungs instead of the digestive tract. Over time, this led to irritation, inflammation, and repeated infections that mimicked pneumonia and did not respond to conventional treatment.
Due to their deep location and the delicate condition of the surrounding tissue, removing the nuts required expert precision.
Dr Chawla, supported by Dr Surjya Upadhyay from the anaesthesia team and experienced endoscopy staff, carried out the procedure under general anaesthesia.
Using a Fogarty balloon catheter - a thin tube with an inflatable tip used to gently dislodge blockages along with specialised forceps designed for foreign body removal, the team was able to carefully extract both fragments. Despite several attempts due to the fragility of the material, the procedure was completed safely and without complications.
The patient's recovery was swift. Within days, his breathing had improved, his energy levels returned, and follow-up imaging confirmed that the collapsed portion of his lung had reopened.
'A cough that lingers for more than two weeks is your body's way of asking for help,' said Dr Chawla. 'This case reminds us that not all pneumonias are caused by infections. Sometimes, the real problem is something hidden, like a foreign body in the airway. With tools like bronchoscopy and EBUS (Endobronchial Ultrasound), we can diagnose and treat these issues quickly and safely, often without the need for surgery.'
While food aspiration is more commonly seen in children, it can also occur in adults, particularly those with underlying health conditions such as diabetes, dental issues, or neurological problems. In many cases, the symptoms are subtle and often mistaken for chronic infection.
Persistent chest infections that don't respond to antibiotics, repeated infections in the same area of the lung, unexplained breathlessness, or findings of partial lung collapse on scans should all raise concern.
At NMC Royal Hospital, DIP, patients have access to a comprehensive range of advanced respiratory diagnostic tools, including bronchoscopy and EBUS. These modern, minimally invasive techniques allow physicians to diagnose and treat airway problems with precision, often avoiding the need for surgical intervention.
When it comes to lung health, early diagnosis and timely action can make all the difference. If you or someone you know is living with a persistent cough or recurring chest infection, expert care is just a consultation away.
To learn more or book an appointment with our pulmonology team, visit nmc.ae or call us at 800 313.