PUZZLER
Worrisome chronic cough in a 3-year-old girl
Shannon D Tiedeken, MD, and Stephen E Shaffer, MD

THE CASE

A 3-year-old girl presents to the emergency department with a 2-day history of worsening cough. Within the last 6 months, she has been diagnosed with gastroesophageal reflux disease (GERD) and asthma as the etiology of her persistent cough, but common medications for asthma and GERD have not brought relief.