title: A 50-year old woman with nasal congestion, cough, and dyspnea.
abstract: We present a 50-year-old woman with progressive dyspnea, cough, and nasal congestion. Evaluation revealed positive skin tests (IgE) to trees and dust mites, early glottic closure on spirometry, and sinus opacities on CT. Diagnostic considerations included allergic and nonallergic rhinitis, asthma, aspirin-exacerbated respiratory disease, vocal cord dysfunction, chronic sinusitis secondary to gastroesophageal reflux disease, and systemic inflammatory and immunologic diseases, including vasculitis. Progresson of her symptoms prompted further investigation, and a biopsy yielded an unexpected diagnosis.
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michagan, USA. jaross1@hotmail.com
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Ross
authors.forename: William J
authors.initials: WJ
authors.lastname: McCune
authors.forename: Georgiana
authors.initials: G
authors.lastname: Sanders
mesh_terms: D003371:Cough / Q000209:etiology*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology*