Differential Diagnosis for a 23-year-old Female with a Chronic Cough
- Single most likely diagnosis:
- Gastroesophageal Reflux Disease (GERD): The patient's symptoms of a dry cough, worsened by lying down and improved by sitting up, along with vomiting when coughing, are suggestive of GERD. The cough is likely triggered by acid reflux, which irritates the throat and causes a tickling sensation.
- Other Likely diagnoses:
- Chronic Bronchitis: Although the patient denies a history of asthma, chronic bronchitis could still be a consideration given her symptoms of cough, wheezing, and shortness of breath. However, the absence of postnasal drip and the nature of her cough (dry and triggered by cold and laughing) make this less likely.
- Vocal Cord Dysfunction: This condition can present with wheezing, cough, and shortness of breath, especially when triggered by laughing or cold air. The fact that she hears wheezing coming from her throat supports this possibility.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary Embolism: Although less likely given the chronic nature of her symptoms and the absence of other risk factors or symptoms like fever or abdominal pain, pulmonary embolism can present with sudden onset of cough and shortness of breath. It's crucial to consider this diagnosis due to its high mortality rate if missed.
- Lung Cancer: Though rare in a young individual, lung cancer can cause a chronic cough. The absence of other symptoms like weight loss, fever, or night sweats makes this less likely, but it should not be entirely ruled out without further investigation.
- Rare diagnoses:
- Sarcoidosis: This autoimmune disease can cause a dry cough, shortness of breath, and wheezing due to granulomatous inflammation in the lungs. However, it typically presents with other systemic symptoms, which this patient does not have.
- Foreign Body Aspiration: Although more common in children, adults can also aspirate foreign bodies, leading to chronic cough and wheezing. The history does not strongly support this, given the duration and nature of her symptoms.