Delayed diagnosis of gastric tube cap foreign body aspiration disguised as status asthmaticus

Foreign body aspiration (FBA) can be difficult to differentiate from asthma exacerbation in a child. Typical presentation includes witnessed aspiration and symptoms of respiratory distress, cough, and abnormal breath sounds. However, it is not uncommon for patients to have an atypical presentation, making the diagnosis of FBA less obvious. The suspicion for FBA should be raised if a patient is being treated for acute asthma exacerbation and does not show clinical improvement following escalation of therapy and ventilator support. If FBA is suspected, an otolaryngologist or critical care specialist will perform a direct bronchoscopy to confirm the diagnosis and remove the aspirated object. Early diagnosis and treatment of FBA is important, as a delayed diagnosis can result in various complications, including pneumonia, respiratory arrest, atelectasis, and even death. While rare, gastric tube cap aspiration can occur in a PEG tube-dependent patient with new onset, dyspnea after a witnessed seizure. It is important to keep a broad differential and have a high index of suspicion for FBA when evaluating a patient with difficulty in breathing.