A 24-year-old man with schizophrenia was admitted to our hospital after a suicide attempt by clozapine overdose. Three weeks later, another patient on the ward reported that he had witnessed the patient injuring his own chest with a pencil. Immediate clinical examination revealed a small pinpoint lesion on the left thoracic wall in the axillary line and seventh intercostal space. Additional surgical examination and wound inspection, as well as an X-ray examination, did not reveal any other abnormalities (Figure 1A).
Moderate signs of infection were treated successfully with sultamicillin, 375 mg b.i.d. for 7 days. During this phase, no subjective clinical symptoms were reported. Ten days later, we observed a rapid increase of infection symptoms. Despite fever and prominent infection signs from laboratory results, the patient reported only mild and inconstant subjective symptoms, such as dull unspecific abdominal pain. A second thoracic X-ray and an ultrasound examination of the abdomen showed no pathologies. A CT examination of the chest finally revealed a foreign body that was 14 cm in length and located in the left basal lobe (Figure 1B). Because of the organic structure of the foreign body, it had apparently been overlooked on both thoracic X-rays. A thoracotomy was performed immediately, and the pencil was removed without any other complications.