The case of a 60-year-old woman with a chronic dry cough which lasted for 4 years is presented. The patient underwent thorough diagnostics. Clinical examination and laboratory tests excluded pathology in the upper and lower airways, which could have been the cause of the cough. An ophthalmological examination revealed a tonic pupil with dissociation of a close light. Neurological findings showed reduced deep tendon reflexes. The above mentioned findings were accompanied by abnormalities of autonomic function, such as orthostatic hypotension and bradycardia while performing the Valsalva maneuver during respiration. Both clinical examination and diagnostic tests made it possible to establish a rare case of Holmes-Adie syndrome.
Conclusion: The presence of a dry chronic cough occurring in a patient without pathology in the upper and lower airways indicates the necessity for ophthalomlogical and neurological examination in order to confirm the existence of Holmes-Adie syndrome.