Ganesh Kasinathan^1,, Naganathan Pillai²

This case report highlights a 55 year old gentleman of Malay descent who presented to the hospital with chronic cough, dyspnoea and night sweats. He is a chronic smoker and works in a rubber plantation. On examination, he was tachypnoeic and tachycardia, febrile and in type 1 respiratory failure. Physical examination was consistent with a right sided spontaneous pneumothorax which was confirmed on a chest radiograph. The chest radiograph also showed evidence of active tuberculosis involving the right upper and middle lobes. His sputum samples smear and culture revealed Mycobacterium tuberculosis complex. He was immediately placed on an intercostal drain with air leak persisting after two weeks. A high resolution CT scan of the thorax showed a bronchopleural fistula measuring 7 mm in diameter in the anterior segment of the right lower lobe. With careful management of the chest drain and early administration of antituberculous chemotherapy, the air leak ceased and the repeated CT scan of the thorax showed obliteration of the fistula. He continued to improve and currently on the 5^th month of treatment. Conclusion: An underlying tuberculosis infection resulting in a bronchopleural fistula should not be missed in a patient from a tuberculous endemic area. Effective careful management of the chest drain and early administration of antituberculous treatment are vital to facilitate the healing of a bronchopleural fistula.

tuberculosis, bronchopleural fistula, chest drain, pneumothorax