The cycle
The cough had lasted for weeks. Chest examination and imaging were reassuring, but repeated antibiotics did not change it.
A better question
Instead of asking only when the cough began, the clinician asked what changed shortly before it began. A blood-pressure medicine had been started around the same time.
The twist
The pattern was consistent with an ACE-inhibitor-associated cough. After medical review and an appropriate alternative, the cough gradually resolved.
Take-home message
Before escalating treatment for a persistent symptom, review the medication list. Drug adverse effects can imitate common diseases.
Diagnostic principle: do not let the first plausible label stop the search when an important detail does not fit.
Educational note: This is a teaching composite, not a substitute for patient-specific diagnosis or treatment. Real patients require direct clinical assessment and appropriate investigations.