Kirschen Gregory W, Kirschen Howard, Gabalski Edward, Waxner Jonathan M, Wohl Agnes
Medical Scientist Training Program (MSTP), Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA.
Child, Adolescent, Adult Psychiatry & Psychotherapy, 366 N Broadway Ste. 210, Jericho, NY, 11753, USA.
Respir Med Case Rep. 2017 Oct 4;22:268-270. doi: 10.1016/j.rmcr.2017.10.001. eCollection 2017.
Chronic idiopathic cough is a common and often frustrating complaint for patients as well as providers. When common etiologies of cough are ruled out and/or do not respond to usual treatments, neurogenic cough should be considered as a diagnosis of exclusion. Here, we report on a 58-year-old woman with an 8-year history of chronic, treatment-refractory cough of unknown etiology that we diagnosed as neurogenic cough and successfully treated with guanfacine monotherapy, with rapid and durable improvement in symptoms. This case was particularly challenging for a number of reasons, including a distant past smoking history and previous pneumonia, a significant psychiatric history, and a mildly deviated nasal septum and nasal osteophyte, all or some of which could have contributed to the etiology of the cough. This case illustrates that neurogenic cough should be a diagnostic consideration in patients presenting with chronic cough in whom other treatment modalities have failed, and also suggests that the therapeutic use of guanfacine in this clinical setting warrants future investigation.
慢性特发性咳嗽对患者和医生来说都是常见且常常令人沮丧的主诉。当咳嗽的常见病因被排除和/或对常规治疗无反应时，神经源性咳嗽应被视为一种排除性诊断。在此，我们报告一名58岁女性，有8年慢性、病因不明且治疗难治性咳嗽病史，我们将其诊断为神经源性咳嗽，并通过单用胍法辛成功治疗，症状迅速且持久改善。该病例因多种原因特别具有挑战性，包括既往有吸烟史和曾患肺炎、显著的精神病史，以及鼻中隔轻度偏曲和鼻骨赘，所有这些或其中一些都可能导致咳嗽的病因。该病例表明，对于其他治疗方式失败的慢性咳嗽患者，神经源性咳嗽应作为一种诊断考虑，并且还表明在这种临床情况下胍法辛的治疗用途值得未来研究。
