Thoracoplasty: A Collapse Therapy for Extra-Pulmonary Drug-Resistant Tuberculosis with Persistent Bronchopleural Fistula and Empyema Cavity

Dantis, Klein; Dey, Chandan Kumar; Phuli, Roopali; Ramavath, Vinod Kumar

Thoracoplasty: A Collapse Therapy for Extra-Pulmonary Drug-Resistant Tuberculosis with Persistent Bronchopleural Fistula and Empyema Cavity

Document Type : Case Report

Authors

Klein Dantis ¹

Chandan Kumar Dey ²

Roopali Phuli ²

Vinod Kumar Ramavath ²

¹ Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bathinda, India

² Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Raipur, India

Abstract

Background: Multi-drug-resistant tuberculosis (MDR-TB) has become a significant health problem worldwide. As per the Global Tuberculosis Report 2021, chemotherapy has only benefitted 59% of individuals. As many patients do not benefit from radical surgery due to their poor pulmonary reserve, bacterial overload, and prognosis, collapse therapy has an essential role in improving the effectiveness of complex anti-tubercular therapy.
Case Presentation: A 35-year-old male with a low body mass index and persistent air leak on an intercostal tube not responding to medical management underwent thoracoscopic decortication. He was diagnosed with multi-drug-resistant tuberculosis (MDR-TB) according to the pleural specimen. Postoperatively, the lung did not seem to expand due to the extensive disease, and the air leak persisted. Hence, he received a short-term MDR-TB regimen and underwent open window thoracostomy followed by limited thoracoplasty for postoperative persistent infected pleural space.
Conclusion: Though pleural MDR-TB is a rare presentation, managing the infected pleural space is challenging as patients tend to have significant morbidity due to various factors.

Keywords

Multi-drug resistant tuberculosis

Bronchopleural fistula

Empyema

Thoracoplasty

Open window thoracostomy

Subjects