SHM Converge Scientific Abstract ePoster Gallery-Persistent Cough as Presenting Symptom of Renal Cell Carcinoma

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This case describes a 76-year-old man with four weeks of persistent, unexplained dry cough accompanied by night sweats, weight loss, and later high fever. Despite treatment for common causes of cough—including antihistamines, cough suppressants, steroids, antibiotics, and switching an ACE inhibitor to an ARB—his symptoms did not improve. He had no respiratory, ENT, or reflux symptoms, and chest imaging was initially normal.<br /><br />During evaluation, he was found to have leukocytosis and mild acute kidney injury. A chest CT incidentally revealed a 5 cm mass in the lower pole of the left kidney with severe hydronephrosis. Urologic evaluation identified narrowing of the left ureter, and pus drainage after stenting confirmed pyelonephritis, which resolved with ceftriaxone and drainage. However, the cough persisted. Further abdominal MRI showed a 5.7 cm complex renal mass suspicious for malignancy. He underwent nephrectomy, and pathology confirmed papillary renal cell carcinoma, grade 2, stage pT1b.<br /><br />Remarkably, his cough resolved completely after tumor removal and did not recur over four years of follow-up. The case highlights persistent cough as a rare paraneoplastic manifestation of renal cell carcinoma. Proposed mechanisms include tumor-related secretion of inflammatory mediators such as IL-6, bradykinin, or prostaglandins, though no single cause has been proven.<br /><br />The key lesson is that when chronic cough remains unexplained after common pulmonary, upper airway, and reflux causes have been excluded, clinicians should consider extrapulmonary etiologies, including malignancy.

Asset Subtitle

Vasanthan Muthusamy Kumarasamy

Meta Tag

Author List Akash Parashar, Ivan Wudexi, Kevin Shiley, Vasanthan Muthusamy Kumarasamy

Category Clinical Vignettes

Concept Renal Cell Carcinoma

Concept Chronic Cough

Concept Paraneoplastic Syndrome

Concept Red Flag

Concept Chest Imaging

Distinguished Non-Finalist

Presenter Organization University at Buffalo-Catholic Health System

Presenting Author Vasanthan Muthusamy Kumarasamy

Track Adult

Keywords

chronic cough

renal cell carcinoma

paraneoplastic syndrome

papillary renal cell carcinoma

persistent dry cough

nephrectomy

hydronephrosis

pyelonephritis

unexplained cough

malignancy

Renal Cell Carcinoma

Chronic Cough

Paraneoplastic Syndrome

Red Flag

Chest Imaging