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 escalating 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 bronchoscopically. When the steroids were tapered, there was marked improvement of the patient's symptoms and resolution of the upper airway intrathoracic obstruction. When patients with asthma are receiving optimal therapy and fail to improve, other causes for their symptoms should be considered.