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A Rare Case of Polymicrobial Empyema Associated With COVID-19 Infection Complicated by a Bronchopleural Fistula

Dhiraj R Regmi1, Sandeep Kshetri2, Laxman Wagle3

  • 1Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, NPL.

Cureus
|July 16, 2025
PubMed

Insights

COVID-19 patients can develop rare empyema (pus in the chest) and bronchopleural fistula (BPF). This case shows conservative management of BPF in COVID-19 empyema can be successful without surgery.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Empyema and bronchopleural fistula (BPF) are uncommon complications of COVID-19.
  • Polymicrobial empyema in COVID-19 patients presents significant management challenges.

Observation:

  • A case of a 40-year-old female with a history of intravenous drug use presented with severe COVID-19, leading to polymicrobial empyema and a bronchopleural fistula (BPF).
  • Initial presentation included hypoxic respiratory failure, leukocytosis, lactic acidosis, and a large hydropneumothorax.
  • Imaging confirmed bilateral lung opacities and a significant pleural effusion requiring drainage.

Findings:

  • Cultures of drained empyema fluid revealed multiple pathogens: Bacteroides fragilis, Arcanobacterium hemolyticum, methicillin-sensitive Staphylococcus aureus, and Group C/G streptococci.
  • Despite initial treatment with antibiotics, antivirals, and corticosteroids, a persistent air leak indicated a BPF.
  • The patient was successfully treated with prolonged antibiotic therapy and chest tube drainage, avoiding surgical or bronchoscopic intervention.

Implications:

  • This case underscores the importance of recognizing and conservatively managing bronchopleural fistulas in the context of COVID-19-associated empyema.
  • Non-surgical resolution is achievable for select cases of small BPFs, highlighting the need for tailored treatment strategies.
  • Further research into optimal management protocols for complex respiratory infections in COVID-19 patients is warranted.
Keywords:
antibioticsbacterial superinfectionbronchopleural fistulacovid pneumoniacovid-19empyemapleural fistulapolymicrobialthoracostomy

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