An Unusual Case of Chronic Cough: Is It Beyond Simple Gastroesophageal Reflux Disease?

Abstract

Esophageal carcinoma commonly presents with dysphagia, weight loss, or retrosternal pain. Less commonly, chronic cough can be the initial presenting symptom, posing a challenge to the physician making the diagnosis. More common etiologies of chronic cough may present similar to those of esophageal carcinoma, making it hard to distinguish malignancy from common causes of cough, such as upper airway cough syndrome (postnasal drip), asthma, and gastroesophageal reflux disease prior to proper imaging. In this case, a 77-year-old male with a one-year history of chronic cough was referred to an allergist and diagnosed with allergic rhinitis. One year later, the patient developed esophageal reflux symptoms and chest pain radiating to the back and visited the Cardiology as well as the Emergency Department. The patient was discharged and referred to gastroenterology, where an endoscopy with biopsy revealed grade 3 adenocarcinoma of the distal esophagus without extension into the cardia. He was treated with chemoradiation followed by distal esophagectomy and has been in remission since treatment for four years. This case displays the importance of keeping differentials broad when treatments for common diagnoses fail to deliver the results physicians would expect.

Keywords: adenocarcinoma; cancer; chronic cough; esophageal carcinoma; gastroesophageal reflux disease; gerd.

Figure 1. Esophagogastroduodenoscopy with dilation (November 11, 2020)

Figure 2. Esophagogastroduodenoscopy with dilation (May 10, 2023)

The green arrows point to the same stricture visualized from different angles in the esophagus