Chronic cough associated with Crohn's disease

Clinically relevant respiratory manifestations of inflammatory bowel disease are very uncommon. They are reported more commonly in association with Ulcerative Colitis and less often with Crohn's disease. The most frequent respiratory manifestation of inflammatory bowel disease is bronchiectasis. We report a case of chronic dry cough in association with Crohn's disease with interesting associated radiology and good response to treatment with steroids.A 62-year-old man presented with dry cough of five years duration with no associated breathlessness or wheezing. He did not report a post nasal drip or systemic symptoms. He was diagnosed to have Crohn's disease with gastro duodenal involvement ten years earlier. The diagnosis was established based upon typical features on a duodenal biopsy. He was treated with prednisolone and mesalazine. The Crohn's disease was in remission in less than a year following which prednisolone and mesalazine were discontinued. He was continued on treatment with a proton pump inhibitor. He worked as a university lecturer. He was an ex-smoker of ten pack years and had stopped smoking ten years earlier. On examination he did not have cyanosis, digital clubbing or significant lymphadenopathy. Examination of the respiratory system was unremarkable. A chest radiograph demonstrated bilateral apical infiltrates (Figure 1). A full blood count, biochemical profile, angiotensin converting enzyme levels and total as well as specific immunoglobulins were all normal.A fibre optic bronchoscopic examination was macroscopically normal. The appearance of the trachea and the bronchial tree was entirely normal. Based on the chest radiograph, a bronchial wash as well as bronchial and trans-bronchial biopsies and were performed from the left upper lobe. The bronchial wash was sterile and negative for acid fast bacilli on stain and culture. The bronchial biopsy showed evidence of a mild inflammatory cell infiltrate, including eosinophils, in the sub epithelial co