Spontaneous Pneumothorax After Rupture of the Cavity as the Initial Presentation of Tuberculosis in the Emergency Department

Abstract

Rare co-existance of disease or pathology Background: Spontaneous pneumothorax can be secondary to a wide variety of lung diseases. Spontaneous pneumothorax secondary to pulmonary tuberculosis occurs in rare cases of residual fibrosis with retractions and bullae. Case Report: We present the case of a 65-year-old male patient from a rural area in the province of Los Ríos in Babahoyo, Ecuador, with no history of contact with tuberculosis. The patient arrived at the Emergency Department of the Regional Hospital of the Instituto Ecuatoriano de Seguridad Social (IESS), Babahoyo, due to acute respiratory failure, preceded by 10 days of evolution due to cough accompanied by greenish expectoration, chest pain, asthenia, and weight loss. On chest radiography, a left pneumothorax and interstitial pulmonary infiltrate were reported. A chest tube was placed, and the patient was intubated and was placed on invasive mechanical ventilation due to severe respiratory failure. Use of the GeneXpert MTB/RIF System detected Mycobacterium tuberculosis without resistance to rifampicin. Ziehl-Neelsen (ZN) staining for the identification of bacillus acid-resistant alcohol was positive in alveolar bronchial lavage. MALDI-TOF mass spectrometry and phenotypic analysis showed the presence of Pseudomonas aeruginosa and Klebsiella pneumonia with carbapenemases resistance mechanism, and the KPC type enzyme was identified. The culture for Mycobacterium tuberculosis was positive from the fourth week. Conclusions: Secondary pneumothorax due to rupture of the polymicrobial cavity and especially of tuberculous origin is a very special form of acute respiratory failure in patients with previous structural pulmonary lesions in the Emergency Department.

Spontaneous Pneumothorax as a Complication in Concomitant Diabetic Ketoacidosis and Pulmonary Tuberculosis: A Case Report

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The Role of Serial Physical Examinations in Diagnosis of a Tension Pneumothorax Secondary to Alveolopleural Fistula

“…In addition, the presence of an infective cavitary lesion in our patient keyed us into her susceptibility of developing a TNP. While the exact mechanisms behind the formation of TNP and acute pulmonary failure secondary to infection are not fully understood, it is postulated that the infective cavitary lesion weakens the lung tissue through the release of lytic enzymes increasing the chances of wall rupture [3]. Thus, it is pertinent that a high-risk assessment should be done on initial encounter to stratify the patient's risk for TNP and serial chest exams can be used to supplement vital sign to define their clinical picture.…”

Spontaneous tension pneumothorax: a devastating consequence of pulmonary tuberculosis

“…2,3 TB has long been recognized and documented as a cause to secondary spontaneous pneumothorax, occurring in approximately 1.3-5% of individuals with pulmonary TB. [4][5][6] Despite being preventable and often curable illness, in 2022 TB was world's 2 nd leading cause of death from single infectious agent, surpassed only by coronavirus disease (COVID-19). TB caused nearly double number of In this report, we present a devastating case of spontaneous tension pneumothorax associated with undiagnosed and untreated pulmonary TB.…”