UNUSUAL ETIOLOGY OF COUGH IN A WOMAN WITH ASTHMA

A case of multiple symmetric lipomatosis (Madelung's disease) acquired through chronic use of corticosteroids is reported. Presumed symptoms of asthma, which consisted of a barking cough, were treated with esca lating doses of steroids. We postulate that excessive use of steroids led to extensive mediastinal fatty infiltration with narrowing of the trachea and mainstem bronchi as noted both radiographically and bronch oscopically. When the steroids were tapered, there was marked improvem ent of the patient's symptoms and resolution of the upper airway intra thoracic obstruction. When patients with asthma are receiving optimal therapy and fail to improve, other causes for their symptoms should be considered.