Indirect formaldehyde exposure and the appearance of respiratory symptoms

This 70 year-old female patient, previously described as having undergone a toxicant-associated steatohepatitis during her childhood, now represents the core of a follow-up case report. After an apparent complete recovery at 13 years of age, she developed a paroxysmal dry cough, predominantly nocturnal, starting at age 24, during her first pregnancy. A seasonal recurrence was observed and bouts of cough have been resurgent at every subsequent winter. Several diagnoses, including asthma, gastro-esophageal reflux, and chronic pertussis have been suggested, as well as a sequel of her severe scoliosis, but the consequent treatments were of no avail. Moreover, repeated lung function tests have remained normal ever since. We presently propose a possible explanation for the puzzle.