Differential Diagnosis for 90 y/o Patient with Persistent Cough
Single Most Likely Diagnosis
- Chronic Bronchitis or Acute Bronchitis: The patient's symptoms of cough and congestion, which were partially relieved by dextromethorphan, suggest a respiratory infection. The persistence of cough despite initial treatment could indicate a more chronic condition or a secondary bacterial infection.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Given the patient's age and the presence of a GI specialist, GERD could be a contributing factor to the cough, especially if the patient experiences reflux at night, irritating the throat and triggering coughing.
- Asthma or Chronic Obstructive Pulmonary Disease (COPD): These conditions could explain the persistent cough, especially if the patient has a history of smoking or exposure to pollutants. The involvement of a pulmonologist suggests these diagnoses are being considered.
- Postnasal Drip: The patient's initial symptoms of cough and congestion could also be related to postnasal drip, where mucus from the nose drips down the back of the throat, causing irritation and cough.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although the patient was recently evaluated by a cardiologist and started on anticoagulation therapy for atrial fibrillation, the risk of pulmonary embolism cannot be entirely ruled out, especially in a patient with persistent cough and a history of recent cardiac evaluation.
- Lung Cancer: Given the patient's age, a new onset of persistent cough warrants consideration of lung cancer, even in the absence of other symptoms like weight loss or hemoptysis.
- Heart Failure: The patient's history of atrial fibrillation and recent cardiac evaluation makes heart failure a potential cause of cough, especially if there is pulmonary congestion.
Rare Diagnoses
- Sarcoidosis: This autoimmune disease can cause cough among other symptoms and could be considered if other diagnoses are ruled out, especially with the involvement of multiple specialists.
- Interstitial Lung Disease: Conditions like idiopathic pulmonary fibrosis could cause a persistent cough, among other symptoms, and would be considered if other more common causes are excluded.
- Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Cough: Although the patient is on lisinopril, an ACE inhibitor, which is a known cause of cough, the fact that the cough persisted after the initial evaluation and treatment for other conditions makes this less likely but still a consideration.