ABSTRACT Multidrug‐resistant pulmonary tuberculosis (MDR‐TB) complicated by recurrent pneumothorax and bronchopleural fistula (BPF) presents a major clinical challenge. We report a 41‐year‐old man with primary MDR‐TB and a history of moderate smoking who developed recurrent secondary spontaneous pneumothorax due to BPF. Initial management included individualized MDR‐TB therapy, chest tube drainage, and intrapleural catheter placement. Persistent air leak (PAL) and recurrent pneumothorax required surgical intervention. After 2 months of anti‐TB therapy, he underwent video‐assisted thoracoscopic surgery (VATS) for fistula repair, followed by open thoracotomy with decortication and lung laceration repair 3 months later. Imaging revealed paraseptal emphysema, loculated hydropneumothorax, and bilateral fibrocavitary changes consistent with active pulmonary tuberculosis. The patient showed clinical and radiological improvement up to 9 months of therapy, without recurrent pneumothorax or significant air leak. This case highlights the importance of early diagnosis, timely surgery, and multidisciplinary management in managing complex MDR‐TB complications and preventing recurrence.
Primawati et al. (Fri,) studied this question.