Talk about a bad hiccup attack. In a recent case report, doctors describe an elderly man who endured years of incurable hiccups ultimately caused by an allergic condition.

Doctors in Lebanon detailed the strange medical tale in a paper published this month in the Journal of Medical Case Reports. The man’s hiccups got so bad that he eventually had to be hospitalized, at which point doctors discovered an unusual manifestation of a well-known but relatively rare type of allergy. Thankfully, once the cause was discovered, the man received proper treatment and his hiccups finally stopped.

Hiccups are involuntary contractions of the diaphragm, a thin muscle at the base of the chest that primarily helps us breathe. Usually, they’re short-lasting bouts of misery caused by any number of mundane things, such as eating too fast, drinking lots of carbonated beverages, or even getting excited. Rarely, though, hiccups can be a sign of a more serious health problem, especially if they don’t go away after a while.

According to this case report, the man had been suffering for over two years with hiccups that came and went with no rhyme or reason. The man took a variety of medications to help stop the episodes, including baclofen (a muscle relaxant), chlorpromazine (an antipsychotic sometimes used for chronic hiccups), and proton-pump inhibitors (used to treat acid reflux, which can cause chronic hiccups), but nothing seemed to help. The man’s symptoms eventually reached a breaking point, as he began experiencing nonstop hiccups for two weeks straight, along with fatigue, which led him to be hospitalized.

The doctors initially failed to find any clear indication of what was causing the man’s hiccups. But a blood test revealed that he had an unusually high level of eosinophils, white blood cells that help fend off parasitic infections. Unfortunately, these cells also often play a role in causing allergy and asthma symptoms. When everything is normal, about 1% to 4% of an adult’s white blood cells will be eosinophils. But the man had an eosinophil count of 18% and no signs of a parasitic infection. Subsequent tests then confirmed that he had a condition called eosinophilic esophagitis, or EoE.

EoE is caused by a damaging build-up of eosinophils in the esophagus (this can happen elsewhere in the body, too). Though episodes of EoE can be set off by common allergy triggers like certain foods, it’s a different type of dysfunctional immune response than the typical food allergy. Sufferers often experience a delayed reaction to their triggers, for instance, rather than the almost-instantaneous reaction seen with a classic peanut allergy. It’s estimated that nearly a half million Americans have EoE, though its prevalence seems to be increasing over time.

Scientists still don’t know a lot about EoE, including exactly how or why it happens, though genetics are a likely risk factor. But this case was even stranger than most, given the man’s hiccups. More common symptoms of EoE include trouble swallowing, heartburn, and food getting stuck in the esophagus, none of which the man had. His EoE was also found at a much older age than usual; cases are typically diagnosed either early in childhood or when people reach their 30s and 40s.

The doctors looked through the medical literature and found only two other suspected cases of chronic hiccups caused by EoE. One possible explanation for the man’s hiccups is that his EoE caused cells in the esophagus to send wayward impulses to the vagal nerve (an important nerve that communicates with the diaphragm, among many other body parts).

Fortunately, this story has a happy ending. The doctors initially gave him a combination of a proton-pump inhibitor (also a treatment for EoE) with baclofen, which only partially improved his hiccups. But once they switched him to a topical steroid, his hiccups went away within a week’s time and his eosinophil count dropped back to a healthier level.

The case, the doctors say, is a lesson that this allergy condition can sometimes appear in unusual ways. “EoE should be considered in the differential diagnosis in patients presenting with chronic refractory hiccups even when the typical symptoms of EoE are lacking, and prompt treatment with topical steroids should be considered,” they wrote.