A 34-Year-Old male admitted with pulmonary tuberculosis complicated by hydropneumothorax and mediastinal emphysema

• Published in: International journal of mycobacteriology Vol. 11; no. 2; pp. 199 - 201
• Main Authors: Yildiz, Birsen, Aksan, Arzu, Akyüz, Merve, Ortaköylü, Gönenç
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer - Medknow Publications 01.04.2022; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: chest tube; Drug resistance in microorganisms; Emphysema, Pulmonary; hydropneumothorax; mediastinal emphysema; Methicillin; Pulmonary tuberculosis; tuberculosis; hydropneumothorax; mediastinal emphysema; Chest tube; tuberculosis
• ISSN: 2212-5531; 2212-554X
• DOI: 10.4103/ijmy.ijmy_130_20

Spontaneous hydropneumothorax (HP) and mediastinal emphysema (ME) are infrequently presented complications of pulmonary tuberculosis (TB). A-34-year-old Pakistani male presented with dyspnea, productive cough, and right-sided pleuritic chest pain. He had no history of any surgery, TB, comorbid disease, or other serious pulmonary diseases. Chest radiography revealed a right-sided HP and parenchymal infiltration. The laboratory results of pleural effusion showed elevated adenosine deaminase levels with the empyema features. Acid-fast bacilli were detected and Mycobacterium tuberculosis without any drug resistance grew in the culture both in the sputum and pleural fluid. A chest tube was inserted immediately. A prolonged airway leak was detected. Hepatotoxicity protocol has been initialized (due to increased hepatic enzymes in the initial presentation) and followed without observing any complications associated with the treatment. On the 25th day of the standard TB treatment protocol, we observed hepatic enzymes in the normal range. Around 40-days of a hospitalization period, he started developing fever and methicillin-resistant Staphylococcus aureus was detected in the pleural fluid culture. We introduced linezolid to the treatment regimen in addition to the antituberculosis protocol. Although spontaneous ME is a benign disease, it might be life-threatening and difficult to manage when complicated with HP and active TB infection. Active TB should be considered a differential diagnosis once ME or HP was detected, and treatment should be started immediately for both diseases.