Oesophago-bronchial fistula causing cough and recurrent lower respiratory tract infections in a patient with Crohn's disease

A40-year-old non-smoking woman was referred to the outpatient clinic because of an increasing dry cough and recurrent lower respiratory tract infections over a 10-year period. The patient was diagnosed with Crohn's disease in 1979. The disease was initially confined to the large intestine but despite intensive medical treatment she required a total colectomy with ileostomy formation and, 2 years later, she was treated with a proctectomy. In 1996 she developed a problematic nocturnal cough with associated early morning sputum expectoration and intermittent wheeze, which did not respond to a trial of inhaled bronchodilators. In 1998 she was admitted to hospital with a severe left lower lobe pneumonia, which responded well to oral ampicillin and erythromycin. She subsequently complained of coughing during meals but denied any indigestion or heartburn. There was no background of atopy, or history of asthma or rhinitis. Systemic examination was unremarkable. Review of previous chest radiographs revealed recurr...