“Dr. Sanders, I’m still sick”… It was strange, she told me; she was fine during the day — with maybe the occasional cough — but at night, when she lay down, it was unbearable. She slept in a chair the past two nights, because in bed she kept waking up to cough. And the day before, she had a strange pressure in her chest… Cough is the most common single reason for a visit to a primary-care doctor. Most of the time it’s caused by an upper-respiratory infection or a cold. But that type of cough usually resolves on its own. A persistent cough has many possible causes. The most likely is an allergy… Now she was back, sicker than ever, and I was starting to get nervous. I had already referred her to an ear, nose and throat doctor and a gastroenterologist. If none of this panned out, I wasn’t sure what to do next.
Lisa Sanders. (4 Jun 2013). The Cough That Wouldn’t Stop. http://archive.nytimes.com/www.nytimes.com/interactive/2013/06/16/magazine/diagnosis-cough-that-wouldnt-stop.html?_r=0#/#abnormal. The New York Times.
On Thursday, we challenged Well readers to unravel the mystery of a 75-year-old woman with a cough that lasted for months. In addition, we asked you to tell us what kind of test you would order to clinch the diagnosis.
The correct diagnosis is…
Lady Windermere syndrome
And the necessary test is…
A culture of the patient’s sputum
… Lady Windermere syndrome is an infection of the lung caused by mycobacterium avium-intracellulare, a bacterium related to the bug that causes tuberculosis. This bug is ubiquitous and commonly found in dust and dirt, in households and farmyards.
Lisa Sanders. (7 Jun 2013). Think Like a Doctor: A Cough Solved. https://well.blogs.nytimes.com/2013/06/07/think-like-a-doctor-a-cough-solved/. Well Blog. The New York Times.
- [… she writes the popular Diagnosis column for the New York Times Magazine and the Think Like a Doctor column featured in the New York Times blog, The Well. Her column was the inspiration for the Fox program House MD (2004-2012) and she served as a consultant to the show.] Lisa Sanders, MD, FACP. Associate Professor of Medicine (General Medicine). Biography. https://medicine.yale.edu/intmed/people/lisa_sanders.profile. Yale School of Medicine.
- Rhinitis – 鼻炎 [post on condition affected by coughing]