Pleural Thickening: A Complication of Tubercular Pyo-pneumothorax

Abstract

In this study, we report a case of a 34-year-old male presenting with pleuritic chest pain, breathlessness on exertion, and weight loss. His history and initial investigations revealed a right-sided pleural effusion, which required intercostal drainage (ICD) insertion, but the effusion was incompletely drained. Pleural fluid cytology, Adenosine deaminase unit (ADA) levels, and sputum (MTB CBNAAT) testing indicated that the pleural effusion was tuberculous in origin. The patient had been discharged on anti-tubercular drugs two months prior. However, two months later, he presented with the same symptoms, and a repeat HRCT-thorax showed a right-sided pleural effusion, suggestive of a pyo-pneumothorax with pleural thickening. A pigtail catheter was inserted to drain the effusion, and the pus sample was sent for culture, which isolated Klebsiella pneumoniae. The pleural fluid contained a large amount of fibrin, which led to pleural thickening, adhesions, and even calcification. Diffuse pleural thickening (fibrothorax) can result from empyema, hemothorax, or tuberculous pleurisy. Currently, definitive preventive and curative measures are limited, with decortication of pleural fibers or thoracoplasty being feasible when pleural thickness is approximately 0.5 cm, which can significantly reduce adhesions in the visceral pleura and lung tissue. This report aims to raise awareness among clinicians about the importance of early diagnosis, appropriate treatment, and the need for prompt and complete drainage of pleural effusion to prevent pleural thickening, calcification, and severe restrictive ventilation disorders.