Japanese clinicians have warned not to trivialise persistent hiccups when accompanied by coughing, with their case report illustrating how a persistent and prolonged bout was a sign of a much more severe problem.
MedPage Today reports that a 55-year-old man first went to a local clinic seeking help for hiccups that lasted more than two weeks, as well as non-productive cough and insomnia that followed.
According to Hiraku Sedogawa, MD, of Saiseikai Niigata Kenoh Kikan Hospital in Niigata, Japan, and Takeshi Ueda, MD, of Rakuwakai Marutamachi Hospital in Kyoto, the patient was initially given a short-acting beta-agonist inhaler, clarithromycin, and a traditional Japanese herbal treatment.
However, symptoms persisted, they reported in the Annals of Internal Medicine: Clinical Cases.
When his symptoms had not abated for several more days, he went back to the clinic, and was given vonoprazan for presumed gastro-oesophageal reflux disease, along with the muscle relaxant dantrolene.
Without any additional improvement, he was referred to the authors, who wrote that most baseline tests turned up normal – though the patient did have a history of dyslipidemia.
Given the lack of findings, they scheduled an upper gastrointestinal endoscopy and contrast-enhanced CT scan of the torso for one week later. They also stopped all of his medications.
The CT scan revealed “filling defects” – areas of darkness on the scan that can signal occlusion or blockage – in both pulmonary arteries. Doppler ultrasound also revealed thrombus formation in the right femoral vein.
With no abnormalities on endoscopy, the authors diagnosed deep vein thrombosis (DVT)-associated pulmonary embolism and immediately started the man on direct oral anticoagulation.
His hiccups went away within a week, and after follow-up testing for other clotting disorders came back negative, was told to continue on his anticoagulants. He remains asymptomatic and his hiccups haven’t returned, the authors reported.
Lulu Wang, MD, an emergency physician at MedStar Health in Washington, who wasn’t involved in the case report, noted that a case like this is rare: she’s seen only one similar case in her decade-long career.
Wang said she wouldn’t “jump to a CT as the first line of investigation” for hiccups unless they weren’t responsive to first-line treatment, lasted for an extended period, or the patient had co-occurring chest pain, high heart rate, low oxygen, one-sided leg swelling, or a recent surgery.
“What worked really well in this case was that the patient kept coming back,” Wang told MedPage Today. It wasn’t until his third visit to a medical facility that he received a diagnosis.
“In the emergency department, we always tell people, ‘we’re seeing you at a snapshot in time’. If symptoms aren’t getting better, certainly if they’re getting worse, or even if patients are just concerned, they should come back.”
Zubair Hasan, MD, a pulmonologist and critical care physician at Long Island Jewish Medical Centre in New York, offered a potential explanation for why pulmonary embolism could have triggered the hiccups.
“It’s likely that the complex interplay of nerve signalling between the lungs and the brain was interrupted when the embolism disrupted blood flow to the lungs.
“That could have irritated the vagus and phrenic nerves in particular, which are responsible for breathing and cough and hiccup reflexes,” Hasan said.
He added that physicians need to “really listen” to the patient, and that patients should be open to sharing any signs and symptoms they experience. Nothing is too small.
“The more detail, the better,” he said.
Sedogawa and Ueda emphasised that clinicians should avoid trivialising persistent hiccups when respiratory symptoms co-exist and should consider serious thoracic or cardiopulmonary disease.
Study details
Pulmonary Embolism Presenting With Persistent Hiccups and Cough: A Diagnostic Challenge
Hiraku Sedogawa and Takeshi Ueda.
Published in Annals of Internal Medicine: Clinical Cases on 18 August 2026
Abstract
Hiccups are usually benign but can occasionally signal serious underlying disease. We report a case of a 55-year-old man presenting with persistent hiccups and non-productive cough as the main manifestations of pulmonary embolism and deep venous thrombosis. Diagnostic imaging revealed bilateral pulmonary emboli and right femoral vein thrombosis, with complete resolution after anticoagulation. This case highlights that hiccups may represent a life-threatening thromboembolic event. Clinicians should avoid trivialising persistent hiccups when respiratory symptoms coexist and should consider serious thoracic or cardiopulmonary disease.
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