Vagal nerve stimulator masquerading as an inhaled foreign body in a child

An 8-year-old girl with a history of cyclin-dependent kinase-like 5 (CDKL5) disorder was presented to the emergency department with a short history of stridor and intermittent respiratory distress following eating a biscuit. She had a background of CDKL5 disorder causing neurodevelopmental delay, including being non-verbal, and refractory epilepsy for which she had received a vagal nerve stimulator (VNS) implanted 2 years prior. On initial examination she was noted to be maintaining her oxygen saturations but with intermittent worsening of her stridor and a barking cough. There was no clear preceding history of …