A 57-year-old white woman presented to our pulmonary clinic with a 4-month history of a chronic nonproductive cough. The cough was persistent and severe. She noted shortness of breath and diffuse chest pain that occurred only during coughing. She previously used an angiotensin-converting enzyme inhibitor, but it had been stopped 2 months prior. She also reported fatigue, night sweats, and a 9 kg (20-lb) weight loss. She was a lifelong nonsmoker and denied any postnasal drip, gastroesophageal reflux symptoms, or history of asthma. She tried treatment with a proton pump inhibitor, azithromycin, benzonatate, and albuterol without significant relief. Results from a previous direct flexible laryngoscopy procedure were unremarkable.