Pulmonary Manifestations of Systemic Disease: Systemic Disease |

An Unusual Case of Chronic Cough and Dyspnea FREE TO VIEW

Anna Michela Gaeta, MD; Anna Annunziata, MD; Gianfranco Scotto di Frega, MD; Giuseppe Fiorentino, MD
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A. O. dei Colli, A. O. R. N. Monaldi, Naples, Italy

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A472. doi:10.1016/j.chest.2016.02.491
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SESSION TITLE: Systemic Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Chronic cough and dyspnoea are the most common symptoms for many respiratory and non-respiratory disorders. In many cases the cause remains unclear without a multidisciplinary approach. We reporte a case in whom chronic cough and dysnoea were associed with Gastric Antral Vascular Ectasia (GAVE syndrome or Watermelon Stomach).

CASE PRESENTATION: A 84 year old non-smoking female presented dry cough with no dyspnoea and wheeze, fatigue and weight loss without anorexia for 2 years. She denied previous history of liver and renal disease. She referred history of rheumatoid arthritis in treatment with low dose of corticosteroid for ten years. Pulmunary function testing demonstrated a mild restrictive pattern with no significant post broncodilator respons, and methacoline airway responsiveness was normal. Skin prick tests were negative, serum total IgE was within normal limits. A high-resolution chest CT scan was performed and found nothing special. Oesophageal reflux was confirmed by 24 h manometry and pH monitoring, so she started a treatment with proton-pump inhibitors and sodium alginate. On review of 2 months lather the reflux symptoms had resolved but the cough was worse and she presented also dizziness and dyspnoea. Laboratory finding showed the hemoglobin was 52 g/l and microcytic hypocromic anemia; faecal occult blood test was positive. Ultrasonic examination of abnomen was normal. The endoscopy showed multiple foci of mucosal erosion around gastic antrum and biopsy pathology of gastric antrum was: moderate superficial crronic gastritis and extensive vasculate ectasias, that were diagnostic of GAVE syndrome. The patient had a iron supplementation and blood transfusion and after that she was admitted to hospital to underwent subtotal gastrictomy. We followed up for 6 months: the patient shoot weight, the hemoglobin was 111 g/l and chronic cought, dizziness and dyspnoea disappeared.

DISCUSSION: Gastric Antral Ectasia (GAVE) is a rare disorder, causes up to 4% of non-variceal upper GI bleeding. GAVE is often associated with systemic illness. The pathophysiological changes leading to GAVE have not been fully explained. Clinic presentation is range from occult bleeding to severe acute upper gastrointestinal bleeding with dizziness and acute dyspnoea. In autoimmune connective tissue disorders, GAVE Syndrome is very common like the pulmonary involvement with cough and dyspnoea.

CONCLUSIONS: A thorough medical history and physical examination is required to diagnose a patient with chronic cought and/or dyspnoea that are most frequently attribuited to a lot of condition like asthma, gastroesophageal reflux or upper airway diseases. Only an integrate algorithm and the consideration of other less common etiologies can lead to the correct diagnosis and the appropriate treatment.

Reference #1: Irwin RS. Complications of cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129(1 Suppl):54S-8S.

DISCLOSURE: The following authors have nothing to disclose: Anna Michela Gaeta, Anna Annunziata, Gianfranco Scotto di Frega, Giuseppe Fiorentino

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