AN UNUSUAL CASE OF CHRONIC COUGH IN A PEDIATRIC PATIENT

Abstract

<h3>Introduction</h3> Common causes of chronic cough in children are postinfectious, asthma, rhinosinusitis, and gastroesophageal reflux. Sensory neuropathic cough (SNC) is a rare cause of chronic cough in children. Its diagnosis is by exclusion; therefore, treatment is often delayed. We present a difficult pediatric case of sensory neuropathic cough. <h3>Case Description</h3> A 12-year-old female with well-controlled asthma developed a new-onset dry to wet cough after a viral infection that persisted for 6 weeks. Symptoms occurred both day and night. No wheezing was reported. She was hoarse but was able to speak in full sentences between coughing. There were no apparent triggers. Initial treatment with daily inhaled corticosteroid, long and short-acting beta-2-agonists, oral leukotriene receptor antagonist, and short courses of systemic steroids failed to relieve her symptoms. The addition of oral histamine-1-and-2-receptor antagonists, intranasal topical steroids and antihistamines, and antibiotics for potential sinus infection was also unsuccessful. Impulse oscillometer and computed tomography of the chest showed no abnormalities. Laryngoscopy was negative for vocal cord dysfunction, pooling of secretions, masses, polyps, or laryngeal swelling. She was seen by a neurologist 8 weeks after the cough began where she was diagnosed with sensory neuropathic cough and started on amitriptyline, resolving her cough. <h3>Discussion</h3> Our case illustrates the challenges of diagnosing sensory neuropathic cough as there are no standardized diagnostic criteria. Peripheral and central neurological sensitization are potential pathophysiologic explanations. Neuromodulating agents such as amitriptyline and gabapentin can potentially provide relief to some. Our patient had resolution of symptoms after use of amitriptyline.