A RARE CASE OF CHRONIC COUGH

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Chronic cough is one of the most common symptoms for which outpatient care sought. The differential diagnosis broad, and many patients undergo extensive evaluation. We here report a rare case chronic with progressive dyspnea due to Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia( DIPNECH), followed by brief literature review DIPNECH. CASE PRESENTATION: 70-year-old female, non smoker, history Crohn's disease presented Pulmonology clinic in 2005 shortness breath. PFT's showed restrictive pattern. CT scan multiple bilateral nodules. Bronchoscopy could not identify cause. On periodic CT, lung nodules remained stable. In meantime, she continued have progressively worsening She received trials steroids, antibiotics, inhalers mild improvement. Repeat now severe obstructive disease. Her coughing spells made it difficult perform on PFTs. underwent repeat bronchoscopy testing, including bacterial, fungal, malignancy, autoimmune causes her symptoms, all came back negative. working was necrobiotic secondary vs. Asthma. put prolonged steroid course developed side effects like muscle weakness, mood changes, tremors kidney function. patient hesitant go steroids. had suffered 17 years. A trial steroid-sparing medication CellCept considered. However, before committing these, wedge biopsy nodule performed revealed cells that stained positive synaptophysin, chromogranin, CD56.8 confirming subsequently referred oncology started Octreotide infusions causing significant improvement symptoms. DISCUSSION: DIPNECH condition becoming increasingly recognized. It typically characterized an insidious onset nonproductive cough, exertional dyspnoea, wheezing, spuriously attributed Asthma, disease, or GERD. Indeed, usually several years after clinical often following incidental discovery (or nodules) imaging, computed tomography (CT). histologically diffuse, bronchiolo-centric proliferation at periphery lung, radiologically ground-glass opacity, mosaic attenuation air trapping, bronchial wall thickening, and, Clinically airflow limitation. CONCLUSIONS: hope this can increase awareness among clinicians as may otherwise be misdiagnosed unnecessary treatments procedures permanent harm. REFERENCE #1: Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia 1Margaret Wei, MD 2Mehri Manouchehr-Pour CLINICAL VIGNETTE1UCLA Department Medicine2UC Riverside Cell, Molecular, Developmental Biology DISCLOSURES: No relevant relationships Venkatkiran Kanchustambham, source=Web Response Swetha Saladi, Khurram Shafique, Vinita Vaidya,