Deglutition-Induced Cough Revealing an Esophagotracheal Fistula Complicating Hodgkin Lymphoma: A Case Report

Acquired esophago-respiratory fistulas are rare and potentially life-threatening complications, most often of neoplastic origin.They are most commonly associated with esophageal or lung cancer, whereas their occurrence in the setting of Hodgkin lymphoma is exceptional.We report a case of a 37-year-old male followed for recurrent or progressive Hodgkin lymphoma under second-line chemotherapy with ICE (ifosfamide, carboplatin, and etoposide) regimen, admitted for a three-month history of chronic cough systematically triggered by swallowing (Ono's sign).Physical examination revealed severe malnutrition (BMI = 16 kg/m²) along with bulky cervical and mediastinal lymphadenopathy.Chest computed tomography (CT) demonstrated an esophagotracheal communication at the T3-T4 level within necrotic mediastinal masses.Endoscopy could not be performed because of respiratory instability.Swallowing-induced cough should prompt investigation for an esophago-respiratory fistula, particularly in patients with mediastinal tumor involvement, even in the absence of dysphagia.Chest CT allows direct identification of the fistulous communication and assessment of the underlying lesion and its complications, especially when endoscopy cannot be performed.