Hiccups, a Rare Presentation of Infective Endocarditis: A Case Report

Document Type : Case Report


1 Assistant Professor of Pulmonary Diseases, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran

2 General practitioner, Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

3 Assistant Professor of Cardiology, Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

4 Assistant Professor of Pulmonary Diseases, Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran; Department of Internal Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman

5 General practitioner, Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran


Hiccup has a wide variety of etiologies irritating the hiccup reflex arc. It is usually benign and self-limited but can be an alarm sign for serious underlying conditions. Hiccup has been rarely reported in patients with infective endocarditis as a result of splenic involvement and phrenic nerve irritation. Herein, we report a 72-year-old man with the chief complaint of long-lasting hiccups (for a 1-month duration) who was diagnosed with infective endocarditis; however, his spleen was grossly intact. The bouts of hiccups repeated 2-3 times a day and lasted for 10-20 minutes. After the initiation of antibiotics, his symptoms waned for a while and appeared again, and then, the hiccups were eliminated. Long-lasting hiccups can be a presentation of serious medical conditions such as infective endocarditis, with or without splenic involvement. Hence, it is important to keep in mind these conditions to perform proper diagnostic and therapeutic workups.


  1. Krakauer EL, Zhu AX, Bounds BC, Sahani D, McDonald KR, Brachtel EF. Case 6-2005: a 58-year-old man with esophageal cancer and nausea, vomiting, and intractable hiccups. New England Journal of Medicine 2005; 352(8):817-25.
  2. Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: to treat hiccups. J Pain Symptom Manage 2009; 38(3):460-5.
  3. Launois S, Bizec JL, Whitelaw WA, Cabane J, Derenne JP. Hiccup in adults: an overview. Eur Respir J 1993; 6(4):563-75.
  4. Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil 2012; 18(2):123-30.
  5. Hosny SM, Rasheedy D. A Case of Intractable Hiccup Ended Badly. Egyptian Journal of Geriatrics and Gerontology 2014; 1(2):19-25.
  6. Kalayc─▒ B, Karabag T, Erten T, Akgun T. Pacemaker lead endocarditis with hiccups (Kalayci). Caspian J Intern Med 2018; 9(3):299-302.
  7. Wiener C, Kasper DL, Fauci A, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine Self-Assessment and Board Review. 19th ed. USA: McGraw-Hill Education; 2016. p. 135-8.
  8. Cunha BA, Lortholary O, Cunha CB. Fever of unknown origin: a clinical approach. Am J Med 2015; 128(10):1138.
  9. Celik T, Kose S, Bugan B, Iyisoy A, Akgun V, Cingoz F. Hiccup as a result of late lead perforation: report of two cases and review of the literature. Europace 2009; 11(7):963-5.
  10. Krysiak W, Szabowski S, Stepien M, Krzywkowska K, Krzywkowski A, Marciniak P. Hiccups as a myocardial ischemia symptom. Pol Arch Med Wewn 2008; 118(3):148-51.
  11. Davenport J, Duong M, Lanoix R. Hiccups as the only symptom of non-ST-segment elevation myocardial infarction. Am J Emerg Med 2012; 30(1):266.