Respiratory challenges in huntington\'s disease: The emergence of hydropneumothorax

Hydropneumothorax, an abnormal collection of fluid and air in the cavity of the pleural space, typically arises by medical interventions such as fluid aspiration or intercostal tube infections. Hydropneumothorax due to tuberculosis is an unusual presentation characterized by the respiratory symptoms such as shortness of breath, cough, fever, in addition to extra pulmonary symptoms. There has been a scanty data on patients presenting with hydropneumothorax due to tuberculosis as its occurrence is relatively rare. Here we present a case of 30-year-old Asian man with Huntington's disease arrived to emergency department with complaints of severe breathing issues, discomfort in his chest, and decreased response. During chest auscultation, a distinct Hippocratic succussion splash was observed which was likely attributed to fluid movement in the right lung. A CT scan indicated considerable fluid accumulations with mediastinal shift and fibro-atelectatic bands in the right lung for which he was diagnosed with hydropneumothorax. Followed which he was put on mechanical respiration and an intercostal drainage tube. Micrococcus were detected after a microbiological investigation. Sputum analysis, tuberculin skin test and PCR analysis revealed the presence of acid-fast bacillus. He then received anti TB drugs along with intravenous piperacillin-tazobactam, inotropic support, nebulization drugs. However, the patient eventually developed sepsis due to the wide spread of the infection.