A 41-year-old male unvaccinated for COVID-19 presented to the emergency department with syncope due to a severe cough, 2 weeks after recovering from COVID-19 for the second time. He demonstrated symptoms of wheezing during the physical exam. However, vitals, lab findings, and the chest CT scan were normal. He was started on proton-pump inhibitors, inhaled antimuscarinic and gabapentin drugs for 7 days on top of a short course of antibiotics, and oral as well as inhaled steroids. His syncopial cough episodes have subsided completely and remain stable. Therefore, clinicians should be aware of the uncommon complication of COVID-19 in the post-acute phase of the disease. Possible predictive factors for syncopal cough are young age, history of COVID-19 infection, as he has been infected twice, and not receiving a COVID-19 vaccine. Gabapentin and antimuscarinic agents may play roles in managing COVID-19-related cough syncope and should be used as part of a multimodal intervention that targets cough, mainly to shorten cough syncope episodes in surviving patients.
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