Alveolopleural fistula with diffuse subcutaneous emphysema – A rare complication of tuberculosis

Abstract: Alveolopleural fistula (APF) is a pathologic communication between the pulmonary parenchyma distal to a segmental bronchus (alveoli) and the pleural space. It presents as a pneumothorax, and if it persists beyond 5 days, it is labeled as a prolonged air leak (PAL). PAL is associated with significant morbidity and prolonged hospitalization. A 70-year-old male patient was admitted with complaints of breathlessness, cough with sputum, and right-sided chest pain for 1 month; the patient had a history of tuberculosis (TB) 1 year ago. Bronchoalveolar lavage was sent for microscopy and cytology which was positive for TB. The patient presented with the above complaints and was managed aggressively in our hospital. Chest tube was inserted. The diagnosis of alveolopleural fistula with subcutaneous emphysema secondary to TB was made as there was a persistent air leak. The patient underwent pleurodesis and was started on antitubercular treatment. We were able to successfully manage a morbid complication of TB in a 70-year-old male patient with APF with subcutaneous emphysema and improve the quality of life in this patient.