Post-tubercular bronchopleural fistula with tension hydropneumothorax: a rare case and its management and diagnostic challenges in a low-income country: a case report

Background A bronchopleural fistula (BPF) accompanied by tension hydropneumothorax is a rare but potentially life-threatening complication of tuberculosis, posing significant diagnostic and treatment challenges. Effective management requires a multidisciplinary approach, particularly when there are additional concurrent infections involved. Case presentation A 28-year-old Black Ethiopian male with no significant past medical history presented to the emergency department with a 1-week exacerbation of shortness of breath, alongside a 2-month history of productive cough, weight loss, and night sweats. He was diagnosed with tuberculosis via GeneXpert testing and subsequently bronchopleural fistula complicated by hydropneumothorax with imaging. Management consisted of chest tube drainage, intravenous antibiotic therapy, and standard first-line antitubercular treatment. The patient showed significant improvement and was discharged in stable condition. Conclusion This case highlights a rare complication of cavitary tuberculosis and demonstrates that bronchopleural fistula can be successfully managed with nonsurgical approaches, resulting in clinical recovery and lung re-expansion, while also providing insights into diagnostic and management strategies.