|Year : 2021 | Volume
| Issue : 2 | Page : 75-76
Chronic cough with fever
Vishnu M Sharma, MB Sohail Mohammed
Department of Respiratory Medicine, A. J. Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India
|Date of Submission||03-Feb-2021|
|Date of Acceptance||24-Mar-2021|
|Date of Web Publication||21-Jun-2021|
Dr. Vishnu M Sharma
Department of Respiratory Medicine, A. J. Institute of Medical Sciences and Research Center, Kuntikana, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
In a country like India where the burden of tuberculosis is high, pulmonary tuberculosis is the first differential diagnosis when a patient presents with chronic cough, fever, and weight loss. However, many other infectious and noninfectious diseases also can present with similar symptoms. Infra diaphragmatic lesions also can present with chronic cough with fever and weight loss. We present a rare case of bilateral suprarenal mass diagnosed as Non-Hodgkin lymphoma presenting with chronic cough, fever, and weight loss. We aim to highlight extra thoracic causes for chronic cough with fever in this article.
Keywords: Chronic cough and fever, extra thoracic causes, infra diaphragmatic causes
|How to cite this article:|
Sharma VM, Sohail Mohammed M B. Chronic cough with fever. J Adv Lung Health 2021;1:75-6
An 18-year-old male patient was admitted with a history of intermittent fever, dry cough, and weight loss for 3 months. He had no other symptoms. Detailed history, physical examination, and chest radiograph did not reveal any specific cause for his symptoms [Figure 1]. Abdominal ultrasound was done followed by computed tomography (CT) scan of the abdomen [Figure 2]. What is the most likely cause for his symptoms?
Answer – Bilateral adrenal mass, left-sided mass abutting the diaphragm leading to chronic cough.
Chest X-ray posteroanterior (PA) view appears normal. Abdominal ultrasound image showed bilateral adrenal mass. CT scan of the chest and abdomen confirmed the ultrasonography findings. Left-sided mass was abutting the diaphragm. There was no other abnormality. CT guided biopsy from the mass showed diffuse large B-cell type Non-Hodgkin lymphoma. He was started on chemotherapy and the lesion regressed with two cycles of chemotherapy. His cough completely subsided after two cycles of chemotherapy. Diaphragmatic irritation by the left-sided lesion was the cause for his chronic cough.
In high-burden countries for tuberculosis, the most common cause for fever with chronic cough and weight loss is pulmonary tuberculosis. However, many other diseases also can present with similar symptoms. Infra diaphragmatic lesions can present with chronic cough. Cause for cough in infra diaphragmatic lesions is most often due to irritation of the diaphragm by the lesion abutting or infiltrating the diaphragm. Chronic aspiration due to gastroesophageal reflux disease, hiatus hernia, esophageal obstruction also should be considered as a differential diagnosis for chronic cough. Liver abscess, subdiaphragmatic or sub-phrenic abscess can cause fever with chronic cough. Paraneoplastic manifestation in renal cell carcinoma is a rare cause for chronic cough and fever.
When there is no obvious cause for cough, extrathoracic lesions should be considered even in the absence of extrathoracic symptoms. These include lesions in the upper gastrointestinal tract, subdiaphragmatic lesions, external auditory meatus, and middle ear. Impacted wax in the ear can lead to cough in children. Angiotensin-converting enzyme inhibitors, Beta-blockers, nonsteroidal anti-inflammatory drugs, calcium channel blockers, and nitrates are the common drugs which can lead to chronic cough. Psychogenic cough should be considered when no obvious cause could be found. Psychogenic cough is more common in children, occurs usually when someone is around, watching the child, does not interfere with physical activity or sleep.
Detailed history including any extra thoracic symptoms, psychological stress, medications, focused physical examination and evaluation will establish the cause for cough in the majority of cases. Ultrasound of the abdomen should be considered whenever there is no obvious intrathoracic cause for cough.
| Conclusion|| |
Intra-abdominal lesions can be a cause for fever and chronic cough. Ultrasound of the abdomen should be considered whenever there is no obvious intrathoracic cause for cough.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sreeramareddy CT, Qin ZZ, Satyanarayana S, Subbaraman R, Pai M. Delays in diagnosis and treatment of pulmonary tuberculosis in India: A systematic review. Int J Tuberc Lung Dis 2014;18:255-66.
Moleyar VS. Diseases involving the lung and upper gastrointestinal tract – A Pulmonologist's perspective. Med J DY Patil Vidyapeeth 2020;13:302-5. [Full text]
Sharma MV, Kakkilaya BS, Shekh IA, Bhat AC, Harsha DS. A rare cause for a common symptom. Breathe (Sheff) 2016;12:e64-74.
Birring SS. Controversies in the evaluation and management of chronic cough. Am J Respir Crit Care Med 2011;183:708-15.
Irwin RS, Glomb WB, Chang AB. Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest 2006;129:174S-9S.
[Figure 1], [Figure 2]