A 39-year-old man with a lifelong history of asthma reported recurrent productive cough and wheeze over the previous 2 years. Antibiotics and specific asthma treatment produced only temporary decreases in symptoms. Chest examination revealed monophonic wheeze in the right mid and lower zones. The appearance on computed tomography was unremarkable.

On flexible bronchoscopy, the blue end-cap of a ballpoint pen was seen within the apical right lower-lobe bronchus (Figure, A and B). It was removed by rigid bronchoscopy (Figure, C). Subsequent questioning of the patient revealed no history of aspiration, although he habitually chewed his pen while working.

Airway foreign bodies are more common in childhood1 and are often not considered in adults. This case underscores the clinical significance of a monophonic wheeze,2 which may arise from abnormalities not detectable by imaging.