Abstract Background Chronic cough in pediatric populations constitutes a frequent yet diagnostically complex presentation, often requiring a multidisciplinary approach to identify underlying etiologies. While respiratory and allergic disorders remain the predominant causes, persistent cough can also arise from systemic or extrapulmonary pathology. Increasing recognition of autoimmune and immune-mediated conditions presenting with atypical respiratory symptoms underscores the need for a broadened diagnostic perspective in chronic cough evaluation. Case Presentation We report the case of a 5-year-old female with a history of recurrent otitis media and a chronic, non-productive cough persisting for over two years. Despite multiple diagnostic assessments and therapeutic interventions—including inhaled corticosteroids, antibiotics, and chest radiographic imaging—her symptoms remained refractory. A comprehensive Aerodigestive multidisciplinary work-up with triple endoscopy ultimately revealed duodenal villous atrophy consistent with celiac disease. Discussion Celiac disease is a chronic, immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed individuals. While primarily associated with gastrointestinal symptoms, numerous extraintestinal manifestations have been described, including otolaryngologic and respiratory features 1,2,3. The mechanisms underlying atypical, extraintestinal presentations may involve systemic immune dysregulation, chronic inflammation, or nutrient malabsorption contributing to multi-organ mucosal vulnerability 2,4. Recognition of such atypical presentations is critical for early diagnosis and improved outcomes, especially in pediatric populations. Conclusion This case underscores the need to include systemic autoimmune disorders, including celiac disease in the differential diagnosis of chronic, treatment-resistant cough in children, even in the absence of gastrointestinal manifestations. This abstract is funded by: None
Tiano et al. (Fri,) studied this question.