Pleurostomy for Persistent Tuberculous Empyema with Broncho Pleural Fistula: A Case Report From the Festoc Center in Bamako

Thoracic empyema (TE) is a pyogenic infection of a previously sterile pleural cavity characterized by an accumulation of pus [1]. Its tuberculous form is the most frequent and represents a late and serious complication of tuberculous pulmonary infection [1]. We report the case of a 30-year-old patient who had been followed up since 2021 in a country of the sub-region for bifocal tuberculosis (pulmonary and pleural). Her symptoms were nocturnal fever with sweating, rest dyspnea and basithoracic pain. This was associated with a productive cough bringing up yellowish sputum, and weight loss. She had been on anti-tuberculosis treatment for six months and underwent left pleural drainage, which returned frank pus. The thoracic CT scan showed a large left hydropneumothorax with homolateral pulmonary collapse. She underwent a second left thoracic drainage, which initially yielded 2 liters of frank pus and air. The postoperative period was marked by persistent drain production in excess of 200ml/24h and the presence of a broncho pleural fistula. A left pleurostomy was recommended and performed. Cytobacteriological examination of the fluid carried out 1 month after pleurostomy isolated Pseudomonas Aeruginosa (B. pyocyanicus) and Klebsiella pneumoniae. The evolution was favorable, with disappearance of the pleural effusion and progressive spontaneous closure of the pleurostomy cavity. Thoracoplasty with closure of the pleurostomy orifice was not necessary.