A 51-year-old man had recurrent episodes of syncope associated with coughing.

Our patient had recurrent episodes of syncope after prolonged episodes of coughing. He had a history of non-Hodgkin lymphoma diagnosed 6 years previously, treated with chemotherapy and autologous stem cell transplant. He was diagnosed with mantle cell lymphoma. He did not have a history of reactive airway disease and had not been treated with angiotensin-converting enzyme (ACE) inhibitors. A pacemaker had been previously deployed after an episode of syncope that occurred while coughing while driving his car, but he was never found to have any cardiac rhythm abnormality or cardiac conduction defect. On neurologic examination, he had evidence of a sensorimotor polyneuropathy with generalized areflexia, and impaired position and vibration sense in both legs.

He had a normal awake and sleep electroencephalography (EEG). Video EEG was unremarkable. Echocardiography showed no evidence of intracardiac infarct or vegetations. There was normal left ventricular ejection fraction. Computed tomography (CT) of the neck showed subtle-appearing focus of decreased density with a rim of increased density involving the right sternocleidomastoid, probably related to prior biopsy in this region. CT angiogram of the neck demonstrated no evidence of arterial stenosis or occlusion. Chest x-ray was unremarkable. EMG/nerve conduction velocities (NCVs) showed a moderate-severe sensory motor polyneuropathy in the lower limbs with mixed axonal and demyelinating features. Cultures of nasopharyngeal aspirate were positive for Bordetella pertussis by DNA polymerase chain reaction (PCR) and negative for Bordetella parapertussis and also negative for Bordetella holmesii.