Differential Diagnosis
The patient's symptoms of an itchy throat, coughing at night more than during the day, and the absence of fever, runny nose, or postnasal drip can be analyzed as follows:
- Single most likely diagnosis
- Allergic rhinitis or asthma: The itchy throat and nighttime cough suggest an allergic component, possibly exacerbated by allergens like dust mites in bedding or pet dander. The lack of systemic symptoms like fever points towards an allergic rather than infectious cause.
- Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): Nighttime cough can be a symptom of GERD, where stomach acid refluxes into the esophagus, irritating the throat and triggering cough. The itchy throat could be related to the irritation.
- Postnasal drip syndrome (without overt symptoms): Even though the patient denies runny nose or postnasal drip, it's possible for mucus to trickle down the back of the throat and cause irritation and cough, especially at night when lying down.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism: Although less likely, a cough that worsens at night could be a symptom of a pulmonary embolism, especially if there are underlying risk factors such as recent travel, surgery, or family history of clotting disorders.
- Cardiac failure: Nighttime cough can be a symptom of heart failure, as fluid accumulates in the lungs when lying down, leading to coughing.
- Rare diagnoses
- Eosinophilic esophagitis: This condition involves an allergic inflammatory response in the esophagus, which could cause an itchy throat and cough, especially if food allergens trigger the condition.
- Vocal cord dysfunction: This condition can mimic asthma and cause cough and throat irritation, often triggered by stress, strong odors, or other irritants.