A 67-Year-Old Woman With Intractable Cough and Dyspnea After Catheter Ablation for Atrial Fibrillation

A 67-year-old woman with diabetes mellitus, hypertension, and atrial fibrillation, but no smoking history, sought treatment for chronic cough, dyspnea, and intermittent expectoration of small, thread-like fibrinous bronchial casts. The medications she was taking included metformin, amlodipine, metoprolol, flecainide, and apixaban. She also had been receiving inhaled formoterol plus fluticasone combination for asthma, diagnosed 1 year earlier. Approximately 2 years earlier, she had undergone catheter ablation for atrial fibrillation. About 6 months after the procedure, she demonstrated a persistent dry cough lasting nearly 1 year, later accompanied by expectoration of small, thread-like fibrinous bronchial casts. She had no history of immunodeficiency (including HIV), immunosuppressive therapy, eosinophilia, allergy, fever, leukocytosis, pneumonia, heart failure, viral infection, or occupational exposure.