Differential Diagnosis for Patient with Chronic Cough

The patient presents with a cough lasting three months, accompanied by vomiting, indigestion, and intermittent productive cough with green phlegm. Recent vaping history and unknown allergies are also noted. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Gastroesophageal Reflux Disease (GERD): The patient's symptoms of indigestion and cough that worsens to the point of vomiting, despite trying acid relief medicine, suggest GERD as a primary cause. The intermittent nature of the cough and its association with indigestion further support this diagnosis.

• Other Likely Diagnoses

  • Chronic Bronchitis: The productive cough with green phlegm and the chronic nature of the symptoms could indicate chronic bronchitis, especially with the recent history of vaping, which can irritate the bronchial tubes.
  • Asthma: The intermittent cough and potential for allergies (though unspecified) could suggest asthma, particularly if the cough is worsened by vaping or other irritants.
  • Allergic Rhinitis: Given the patient's report of allergies, though unspecified, allergic rhinitis could contribute to the cough, especially if postnasal drip is present.

• Do Not Miss Diagnoses

  • Pulmonary Embolism: Although less likely given the chronic nature of the symptoms, any cough that is severe enough to cause vomiting could potentially be a sign of a pulmonary embolism, especially if there are other risk factors present.
  • Lung Cancer: In a patient with a history of vaping and a chronic cough, lung cancer, although rare, must be considered, especially if other symptoms such as weight loss or hemoptysis are present.
  • Tuberculosis (TB): The productive cough with green phlegm could suggest TB, particularly if the patient has been exposed to someone with TB or has risk factors for TB.

• Rare Diagnoses

  • Cystic Fibrosis: Although typically diagnosed in childhood, cystic fibrosis could present in adulthood with chronic productive cough and recurrent infections.
  • Bronchiectasis: This condition, characterized by damaged bronchial tubes, could result in a chronic productive cough and might be considered if other diagnoses are ruled out and symptoms persist.
  • Eosinophilic Esophagitis: Given the patient's symptoms of indigestion and vomiting with coughing, eosinophilic esophagitis, an inflammatory condition of the esophagus, could be a rare but possible diagnosis.