Bronchopleural Fistula in Tuberculosis: A Challenge to Mechanical Ventilation

Pulmonary tuberculosis (TB) remains a significant cause of morbidity and mortality worldwide, particularly in resource-limited settings. Bronchopleural fistula (BPF) is a rare yet life-threatening complication of TB, presenting substantial diagnostic and therapeutic challenges. Its effective management demands a multidisciplinary approach, especially when compounded by concurrent infections and severe malnutrition. We present the case of a 39-year-old male with a history of chronic alcohol use and heavy smoking, who presented with severe cachexia, pneumothorax, and a persistent air leak. Diagnostic evaluations confirmed TB complicated by BPF and superinfection with Streptococcus pneumoniae. Despite initiating antitubercular therapy, antibiotics, and thoracic drainage, the patient's condition deteriorated rapidly. Given the high surgical risk, conservative measures, including single-lung ventilation and supportive care, were employed. However, his clinical course was marked by progressive respiratory distress, refractory septic shock, and multiorgan failure. Despite exhaustive supportive efforts, the patient succumbed to the illness on the eighth day of hospitalization. This case underscores the complexities of managing TB-associated BPF, particularly in patients with severe malnutrition and coexisting infections. It highlights the critical need for early diagnosis, individualized interventions, and close multidisciplinary collaboration to optimize outcomes in such challenging scenarios.