Large Vessel Vasculitis with Chronic Cough

Abstract

A 57-year-old woman presented with a 1-month history of dry cough and weight loss. She had a history of polymyalgia rheumatica (PMR) that had been diagnosed at 55 years old. Dullness in both upper limbs with elevated inflammatory markers and improvement with low-dose prednisolone might have led to this diagnosis, although her chief complaint at that time was a chronic cough. After excluding pulmonary diseases, contrast-enhanced computed tomography showed wall thickening of the descending aorta (Picture 1); positron emission tomography revealed an intense fluorodeoxyglucose uptake in the same areas (Picture 2). Following a diagnosis of large-vessel vasculitis (LVV), all symptoms improved with high-dose prednisolone. One of tt hypothesized mechanisms of cough in LVV is arterial inflammation contiguous to a vague nerve branch (1). As proper selection of radiographs is crucial in diagnosing LVV (2), LVV should be considered as a differential diagnosis of chronic cough, especially in cases with PMR-like symptoms in nontypical age groups.