SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: CS is an extremely infrequent but often disabling clinical presentation. Several disorders have been associated with its presentation. We describe a case of recurrent CS, most likely related to tracheobronchomalacia. The patient was subsequently started on Pregabalin, with complete resolution of these episodes. CASE PRESENTATION: A 68-year-old Caucasian male presented to the clinic with a one-year history of repeated episodes of syncope. Loss of consciousness would occur after fits of significant dry coughing. He denied having palpitations or chest discomfort prior to syncopal events. He had recently suffered a small right frontal intraparenchymal hemorrhage due to head trauma sustained during his last episode. The patient was a bus driver. He was a lifelong nonsmoker. Past medical history consisted of moderate obstructive sleep apnea on continuous positive airway pressure therapy, well-controlled gastroesophageal reflux disease, upper airway cough syndrome, dyslipidemia, hypertension, and hypothyroidism. His medications included pantoprazole, fluticasone furoate nasal spray, atorvastatin, bisoprolol, amlodipine, chlorthalidone, and levothyroxine. He came to the clinic wearing a helmet, out of fear of future post-syncopal head trauma. On examination, blood pressure was 134/77 mm of mercury, heart rate 68 beats per minute and oxygen saturation was 97% on room air. Body mass index was 37. Bilateral expiratory wheezing was present on respiratory auscultation. Cardiac examination was unremarkable. Bloodwork was noncontributory. Chest imaging was unrevealing, aside for a stable 9 mm right lower lobe pulmonary nodule seen on computed tomography. Spirometry was within normal limits, and methacholine challenge testing was negative. A recent echocardiogram was unremarkable aside for mild diastolic dysfunction. Holter monitoring and Persantine myoview stress test were both normal. Bronchoscopy revealed tracheobronchomalacia, with approximately 80% endobronchial narrowing on simple exhalation; cultures performed were negative. The patient was subsequently started on Pregabalin, with a gradual increase of the total daily dose to 300 mg. Dramatic improvement in regards to cough frequency and severity was rapidly seen. CS did not recur, and he was subsequently able to resume commercial driving. DISCUSSION: CS has been described with several different underlying pulmonary disorders including asthma, cystic fibrosis, pertussis, influenza, and tracheobronchomalacia. It seems to most commonly occur in middle-aged men, often overweight or obese. (1) Pregabalin appeared to be potentially helpful in patients with chronic refractory cough in a small trial. (2) CONCLUSIONS: Recurrent CS is an uncommon presentation, with possibly devastating consequences on patient quality of life. A trial of Pregabalin proved extremely beneficial in this case and should be contemplated in severe refractory chronic cough. Reference #1: Dicpinigaitis, Lim, & Farmakidis. (2014). Cough syncope. Respiratory Medicine, 108(2), 244-251. Reference #2: Vertigan, Kapela, Ryan, Birring, Mcelduff, & Gibson. (2016). Pregabalin and Speech Pathology Combination Therapy for Refractory Chronic Cough: A Randomized Controlled Trial: A Randomized Controlled Trial. Chest, 149(3), 639-648. DISCLOSURES: No relevant relationships by Roland Sabbagh, source=Web Response No relevant relationships by Mathieu Saint-Pierre, source=Web Response