A 34-year-old woman with persistent cough and diarrhea

History A 34-year-old woman was admitted to the hospital with watery diarrhea, pain in the left lower quadrant, and persistent cough. A mild anemia and a leukocytosis with slight shift to the left were the only accompanying abnormal laboratory results. Further history is withheld. A barium enema examination (Fig 1) and a barium esophagram of the upper gastrointestinal tract (Fig 2) were performed. Diagnosis Crohn's disease involving the colon with esophageal involvement producing a tracheoesophageal fistula. Comment At age 24 years, this woman was first diagnosed as having Crohn's disease after developing rectal fistulas and oral ulcerations, both of which resolved with prednisone and sulfasalazine therapy. Five years later, she complained of cough, dysphagia, and watery diarrhea. Endoscopy revealed erythematous, friable mucosa in the midesophagus, which on biopsy was consistent with Crohn's disease. An increase in the intake of steroids resolved the patient's symptoms. She remained symptom free for five